Bronchiolitis Clinical Pathway — Inpatient | Children's Hospital of Philadelphia

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Related Pathway:
ED Bronchiolitis
Pathway

Quality Story
Reducing Albuterol Use in Children with Bronchiolitis

Goals and Metrics

SUPPORTIVE CARE
Suction
Hydration, nutrition
Supplemental oxygen
Pulse oximetry
Fever Management

Guidance for Oral or Enteral Feeding in Bronchiolitis Patients

Child with Bronchiolitis

Additional Treatment Considerations

Albuterol Trial
Racemic epinephrine
Antibiotics
Hypertonic Saline
Score-Treat-Score

Further Diagnostic Testing

Initial Work-up

History and Physical
Bronchodilators not recommended for typical bronchiolitis. If used, document reason and response.
RT: Baseline Assessment
Droplet/Contact Precautions
Determine symptom severity

Severe

Moderate

Mild

Q 1h assessments
Nasal suctioning - Wall
Continuous O₂ monitoring
CR Monitoring
IV fluids/NG tube feeds/PO
as tolerated
Use of HFNC automatically
classifies patient as Severe
HFNC Weaning Recommendations: Bronchiolitis

Q 2h assessments
Nasal suctioning – Bulb/Wall
Intermittent O₂ monitoring
IV fluids/NG tube feeds/PO
as tolerated

Q 4h assessments
Nasal suctioning – Bulb
Intermittent O₂ monitoring
Resume normal feeds

ESCALATION

Consider:
Racemic epinephrine

CAT Call
Make child NPO

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
	1y – 2y	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: January 2016, February 2016, October 2017, March 2018, June 2018
Authors: M. Dunn, MD; J. Zorc, MD; J. Kreindler, MD; L. Tyler, RRT; E. Pete Devon, MD; M. McCloskey,
RN; V. Madrigal, MD; L. McAndrew, MD; A. Barnes, MD; A. Gahman, RN; K. Leach, RN, R. Keren, MD

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.