Bronchiolitis: From Practice Guideline to Clinical Practice

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Key points

  • Bronchiolitis is a common but challenging cause of respiratory distress in infants and children presenting to an emergency department.

  • Emergency physicians must be able to stabilize those patients with escalating illness, distinguish patients with impending respiratory failure, and determine who may be discharged safely home.

  • Emergency practitioner must be familiar with the American Academy of Pediatrics’ clinical practice guideline for bronchiolitis in order to apply best practices appropriately.

The Guidelines

The 2014 update of the AAP’s 2006 bronchiolitis CPG reflects a minimalist approach to bronchiolitis and addresses the care of previously healthy infants and children, most of whom do not need major intervention.1 Before the 2006 CPG, widespread practice variation existed.2 Despite increasing evidence that many bronchiolitis therapies lack effect, several recent studies describe the unnecessary resource and treatment utilization that still occurs globally.3 Many infants still routinely receive

Treatment

Treatment is supportive and includes suctioning, supplemental oxygen, and hydration. Florin and colleagues’8 review describes a global comparison of treatments citing similar approaches worldwide. Newer evidence of common therapies follows in Table 2.

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    Disclosure Statement: The authors do not have a direct financial interest in subject matter or materials discussed in the article or with a company making a competing product.

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