Acute Bronchiolitis

Nota:

• Toxic fumes, viral infections, organ transplantation, connective tissue disease

1. Respiratory Syncytial Virus (RSV)
2. Other

   Nota:

   • Rhinovirus, adenovirus, influenza, parainfluenza

Nota:

• <6 mo, exposure to cigarette smoke, lack of breastfeeding, premature birth (<37 weeks), crowded conditions

Nota:

• Fever, HA, nausea and vomiting, lethargy, myalgias; lasts 1-2 days

1. Followed by: Respiratory Distress

   Nota:

   • Wheezing, rales, tachypnea, nasal flaring, cyanosis, retractions

Nota:

• Single best predictor in children

Nota:

• Using monoclonal antibody testing

Nota:

• CXR shows as nonspecific

Nota:

• Humidified O2, IV fluids, nebulized saline, cool mist humidifier, antipyretics

1. Mechanical Ventilation

1. Ribavirin

Nota:

• Limited role

1. Beta-agonists
2. Nebulized racemic epinephrine
3. Corticosteroids*

   Nota:

   • *Not indicated unless hx of underlying reactive airway disease

1. At High Risk: Palivizumab and HANDWASHING

   Nota:

   • -During the first year of life for children <29 weeks -Symptomatic chronic lung disease of prematurity -Coronary heart disease (CHD) -Neuromuscular difficulties, immunodeficiency

Nota:

• Various complications are possible including those caused by therapy. In most cases, the disease is mild and self-limited. 

Nota:

• In immunosuppressed infants and those with preexisting heart or lung disease, RSV bronchiolitis can result in any of the following:
• Acute ARDS, Bronchiolitis obliterans, CHF, Secondary infection, Myocarditis, Arrythmias Chronic lung disease