Bronchiolitis Clinical Pathway, Emergency Department – Supportive Care

Bronchiolitis Clinical Pathway — Emergency Department

Supportive Care

Supportive care is the primary treatment for infants with bronchiolitis.

Suction
  • Decreases work of breathing by clearing secretions
  • May improve feeding
  • Bulb suction is preferred, especially in infants with low intervention score
  • Wall suctioning is reserved for infants with respiratory distress requiring admission
  • Perform Respiratory Intervention Score before and after
Hydration Nutrition
  • Consider NG feeds if:
    • Poor po intake
    • Moderate respiratory distress
    • Choking with feeds
  • NPO and IVF if:
    • Severe respiratory distress
    • Concern for worsening of respiratory status
Pulse Oximetry
  • Severe Response to Intervention Score: Continuous pulse oximetry is indicated
  • Moderate Response to Intervention Score: Intermittent pulse oximetry (continuous monitoring is not required)
  • Mild Response to Intervention Score: Spot check pulse oximetry with regular assessments
Note: Continuous monitoring has been correlated with longer hospital LOS
Supplemental O2
  • Consider if O2 saturation is consistently:
    • < 90% while awake for > 20 seconds after suction, position
    • < 88% while asleep for > 20 seconds after suction, position
  • Brief desaturations (< 20 secs) less than 90 % in a sleeping infant do not routinely require supplemental oxygen
  • Begin O2 wean when saturations are > 90 %
Fever Management
  • Fever can increase WOB. If the child is febrile, consider use of antipyretic