Bronchiolitis Clinical Pathway, Inpatient – Supportive Care

Bronchiolitis Clinical Pathway — Inpatient

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
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 respiratory status
Pulse Oximetry
  • Severe Assessment: Continuous pulse oximetry is indicated
  • Moderate Assessment: Q2 hr spot check pulse oximetry (continuous monitoring is not required)
  • Mild Assessment: Spot check pulse oximetry with regular Q4 hr assessments
  • Note: Continuous monitoring has been correlated with longer hospital LOS
Supplemental O2
  • Consider if SpO2 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