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Evidence-Based Assessment And Management Of Acute Bronchiolitis In The Emergency Department

March 2011

Abstract

Visits to the emergency department (ED) by infants and young children who are wheezing and in respiratory distress are anxiety-provoking for both parents and ED staff. Emergency clinicians should be aware of the causes of this true medical emergency in infants and children as well as management strategies for handling it prior to progression to respiratory failure. Bronchiolitis is the most common lower respiratory tract infection (LRTI) in infants and young children up to 2 years of age. More than 200,000 visits are made annually to EDs in the United States for bronchiolitis, with a 19% admission rate, making bronchiolitis the leading cause of hospitalization for infants.1,2 Of note, the hospital charges for bronchiolitis alone are estimated at $700 million annually.3 The hospitalization rate for infants with bronchiolitis more than doubled between 1980 and 1996, and the proportion of infant hospitalizations due to bronchiolitis more than tripled.3

This issue of Pediatric Emergency Medicine Practice uses evidence-based medicine to recommend strategies for effective evaluation and treatment of bronchiolitis in pediatric patients.The definition of bronchiolitis, the clinical scoring systems, and outcome measures used in the bronchiolitis literature vary significantly, complicating interpretation of the data (See Table 1) Although excellent published guidelines exist to help clinicians address this common disease, they often exclude the “highrisk” group for severe bronchiolitis (ie, patients who are at risk for serious complications such as apnea and who may need ventilatory support). Particularly helpful in this area is the American Academy of Pediatrics (AAP) Subcommittee on Diagnosis and Management of Bronchiolitis. (See Table 2)4 Novel treatments for acute bronchiolitis such as nebulized hypertonic saline, heliox, and nasal continuous positive airway pressure (nCPAP) are also available and will be discussed in this article.

Keywords: pediatric, wheezing, bronchiolitis, lower respiratory tract infection, RSV, infant respiratory distress, bronchiolitis guidelines, steroids, and asthma.

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