Inpatient Clinical Pathway for Evaluation/Treatment
of Children with Bronchiolitis

Goals and Metrics
Patient Education
Provider Resources
  • Supportive Care
    • Suction
    • Hydration, nutrition
    • Supplemental oxygen
    • Pulse oximetry
    • Fever Management
Updated Monitoring Guidance
National guidelines advise against continuous CRM and pulse oximetry monitoring when a child is not receiving supplemental oxygen or flow.
Child with Bronchiolitis
Additional Treatment Considerations

Further Diagnostic Testing

Mild
Moderate
Severe
  • Q4h assessments and pulse oximetry spot checks
  • Nasal suctioning – Bulb
  • Resume normal feeds
  • Continuous pulse oximetry and CR monitoring
  • PO as Tolerated/Consider NG Feeds, IV Fluids
  • High-flow nasal cannula (HFNC)
    • If severe distress/hypoxemia despite supportive care, initiate HFNC at 1.5 L/kg/min
    • Titrate to max settings using HFNC Job Aid
  • All children on HFNC remain in severe category
Weaning
Escalation
  • If mild/moderate assessments x 4 hr, decrease to1 L/kg/min x 2 hr, then discontinue if remains mild/moderate
  • Discontinue continuous CRM and
    pulse oximetry after 1 hr on room
    air if ≥ 90%
  • Make child NPO
  • CAT call
  • Consider racemic epinephrine
Discharge Criteria

Response to Intervention Score

    Mild (0) Moderate (1) Severe (2)
RR < 3 months 30-60 61-80 > 80
3 - < 12 months 25-50 51-70 > 70
1 years - 2 years 20-40 41-60 > 60
WOB None or mild Intercostal retractions Nasal flaring, grunting, head bobbing
Mental Status Baseline Fussy or anxious Lethargic or inconsolable
Posted: November 2013
Revised: March 2023
Authors: M. Dunn, MD; J. Zorc, MD; L. Tyler, RRT; E. Pete Devon, MD; L. McAndrew, MD; K. Leach, RN