Acute Bronchiolitis: Assessment and Management in the Emergency Department

Points and Pearls Excerpt

• Bronchiolitis is the most common lower respiratory tract infection in infants and young children aged < 2 years.
• Respiratory syncytial virus (RSV) and metapneumovirus (HMPV) cause the majority of cases.
• Bronchiolitis is a clinical diagnosis, defined by the American Academy of Pediatrics (AAP) as “rhinitis, tachypnea, wheezing, cough, crackles, use of accessory muscles, and/or nasal flaring in infants.”
• There can be a variable degree of edema and narrowing of the small airways, with mucous plugging, atelectasis, air trapping, and hypoxemia. Changes in these factors account for the variable clinical presentation of bronchiolitis and the rapid changes in severity of illness.

Most Important References

• Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-e1502. (Clinical practice guideline) 
• Willwerth BM, Harper MB, Greenes DS. Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. Ann Emerg Med. 2006;48(4):441-447. (Retrospective review; 691 patients aged < 6 months) 
• Mansbach JM, Clark S, Christopher NC, et al. Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department. Pediatrics. 2008;121(4):680-688. (Prospective multicenter study; 1456 patients aged < 2 years) 
• Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2006(3):CD001266. (Systematic review; 30 trials, 1992 infants with bronchiolitis) 
• Kelly GS, Simon HK, Sturm JJ. High-flow nasal cannula use in children with respiratory distress in the emergency department: predicting the need for subsequent intubation. Pediatr Emerg Care. 2013;29(8):888-892. (Retrospective cohort review; 498 patients aged < 2 years)