bronchiolitis management

8/17/2019 Bronchiolitis Management

1/21

MANAGEMENTOF

BRONCHIOLITIS

Presented by: Tonyan Thompson


2/21

e!n"t"on

# Bron$h"o%"t"s "s a $ommon seasona% &"ra% "n'e$t"on o' the (pper%o)er resp"ratory tra$t* $hara$ter"+ed by a$(te "n,ammat"on* eand ne$ros"s o' a"r)ay ep"the%"(m %ead"n- to "n$reased m($(sprod($t"on and bron$hospasm.

# Resp"ratory syn$yt"a% &"r(s /RS01 "s the most $ommon $a(se.

# May be $a(sed by other &"ra% a-ents* "n$%(d"n-:

2 human metapneumovirus,

2 adenovirus,

2 infuenza,

2 rhinovirus, and

2 parainfuenza viruses.


3/21

Ep"dem"o%o-y

# The most $ommon %o)er resp"ratory tra$t "n'e$t"on "n "n'ants a$h"%dren 34 years o' a-e.

# It "s the %ead"n- $a(se 'or hosp"ta%"+at"on "n $h"%dren 56 year o

# 7"th"n the !rst 4 years o' %"'e* (p to 89 o' $h"%dren )"%% ha&e "n'e$ted by RS0. O' those* ;9 man"'est )"th a %o)er resp"rato

"n'e$t"on.# Pea< "n$"den$e d(r"n- )"nter months= 2 bet)een No&ember to


4/21

Pathophys"o%o-y# Bron$h"o%"t"s "s "n,ammat"on o' the %o)er resp"ratory tra$t* )"th edema*

$e%% ne$ros"s* bron$hospasm* and "n$reased m($(s prod($t"on )"th"n thbron$h"o%es

# Th"s %eads to &ar"ab%e de-rees o' ate%e$tas"s or hyper"n,at"on o' the %o)a"r)ays.

# Res(%t"n- "n "n$rease "n a"r)ay res"stan$e and de&e%opment o' %o)er a"robstr($t"on %ead"n- to "n$reased )or< o' breath"n-.

# RS0 > transm"tted by d"re$t $onta$t )"th $ontam"nated se$ret"ons* /%ar-

"nto the m($osa o' the eyes and nose1# In'e$ted se$ret"ons 'o(nd on 'om"tes rema"n $onta-"o(s 'or se&era% ho(

# RS0 "s h"-h%y "n'e$t"o(s* th(s se%'>$ontam"nat"on and noso$om"a% spread$ommon.

# Hand )ash"n- and $onta$t pre$a(t"ons are "mportant to %"m"t the spreadd"sease.

# The "n$(bat"on per"od 'or RS0 ran-es 'rom 4 to ? days.


5/21

Presentat"on

# In"t"a% symptoms 2 $%ear rh"norrhea* d"m"n"shed appet"te* 'e&er

# Later Symptoms 2 ta$hypnea* $o(-h"n-* )hee+"n-* dyspnea*"rr"tab"%t"y

# @se o' a$$essory m(s$%es* nasa% ,ar"n-* and 'e&er may a%so o$

# Asso$"ated symptoms "n$%(de "rr"tab"%"ty* $yanos"s* and poor 'e

# A s(bset o' "n'ants may present )"th se&ere d"sease and apne

# Symptoms last on average 7 to 14 days and are often tworst in the initial 3 to 5 days of the illness


6/21


7/21

Presentat"on

# On $hest eam"nat"on* )hee+"n- and $ra$


8/21

"erent"a% "a-nos"s

# Asp"rat"on Pne(mon"t"s andPne(mon"a

# Asp"rat"on Syndromes

# Asthma

# Ba$ter"a% Pne(mon"a

# Ch%amyd"a% Pne(mon"as

# Chron"$ Obstr($t"&eP(%monary "sease /COP1

# Cro(p

# Cyst"$ F"bros"s

# Heart Fa"%(re

# My$op%asma% Pne(mon"a

# Ped"atr"$ Apnea

# Ped"atr"$ Fore"-n Body In-est"on

# Ped"atr"$ Pne(mon"a

# Ped"atr"$ Seps"s

# Pert(ss"s

# 0"ra% Pne(mon"a


9/21

7or< (p

# The diagnosis of bronchiolitis is based on history, clinicalpresentation, the patient’s age, seasonal occurrence, and from the physical e!amination" #hen all of these are conswith the e!pected diagnosis of bronchiolitis, few laboratorare necessary

# Tests are typ"$a%%y (sed to e$%(de other d"a-noses /e-* ba$ter"a% seps"s* or $on-est"&e heart 'a"%(re1 or to $on!rm a &"ra% et"o%o-y adeterm"ne re("red "n'e$t"on $ontro% 'or pat"ents adm"tted to the h

# The Resp"ratory "stress Assessment Instr(ment* )h"$h "s $omposmeas(rements o' )hee+"n-* retra$t"ons* and resp"ratory rate* "s th)"de%y (sed s$or"n- system


10/21


11/21

# The most $ommon tests are:

# Rap"d &"ra% ant"-en test"n- o' nasopharyn-ea% se$ret"ons'or resp"ratory syn$yt"a% &"r(s /RS01*

# Arter"a% b%ood -as /ABG1 ana%ys"s /"n se&ere%y "%% pat"ents* espethose re("r"n- me$han"$a% &ent"%at"on1*

# 7h"te b%ood $e%% /7BC1 $o(nt )"th d"erent"a%*

# C>rea$t"&e prote"n /CRP1 %e&e%* and

# Chest rad"o-raphy.

# Other $ommon tests are p(%se o"metry=* b%ood $(%t(re* (r"ne

and $(%t(re* and $erebrosp"na% ,("d /CSF1 ana%ys"s and $(%t(respe$"!$ -ra&"ty may pro&"de (se'(% "n'ormat"on re-ard"n- ,("dba%an$e and poss"b%e dehydrat"on. Ser(m $hem"str"es are not d"re$t%y by the "n'e$t"on b(t may a"d "n -a(-"n- se&er"ty o'dehydrat"on.


12/21

7or< @p

# The (se o' re&erse>trans$r"ptase po%ymerase $ha"n rea$t"on testdete$t n($%e"$ a$"d oers -reater sens"t"&"ty.

# Res(%ts o' &"ra% $(%t(re are not a&a"%ab%e 'or se&era% days and ar(se'(% 'or -("d"n- E treatment

# $ncillary tests, such as blood wor% and radiographs, areroutinely needed unless other diagnoses need to be e!c

# Chest rad"o-raphs are not ro(t"ne%y "nd"$ated* b(t may be $ons")hen the "%%ness "s se&ere or the $o(rse "s atyp"$a% to ens(re thapne(mon"a "s not present. A%tho(-h the $hest rad"o-raph "n bromay demonstrate pat$hy ate%e$tas"s and hyper"n,at"on* ba$ter"pne(mon"a "s (n(s(a%.


13/21

Treatment

# Be$a(se no de!n"t"&e treatment 'or the spe$"!$ &"r(s e"sts* thd"re$ted to)ard symptomat"$ re%"e' and ma"ntenan$e o' hydraoy-enat"on.

# Med"$a% therap"es (sed to treat bron$h"o%"t"s "n "n'ants and yo($h"%dren are $ontro&ers"a%. A%tho(-h n(mero(s med"$at"ons an"nter&ent"ons ha&e been (sed to treat bron$h"o%"t"s* at present

oy-en appre$"ab%y "mpro&es the $ond"t"on o' yo(n- $h"%dren bron$h"o%"t"s


14/21

Treatment

# Supplemental o!ygen therapy > Ma"nta"n O4 Sat abo&e 89

# &aintenance of hydration ' "t "s &"ta% to ma"nta"n ade(ate hy The -oa% o' ,("d therapy "s to rep%a$e de!$"ts and to pro&"dema"ntenan$e re("rements.

# (entilatory Support > m(st be pro&"ded "' s(pp%ementa% oy-e

not $orre$t hypo"a* or "' resp"ratory d"stress )orsens.2 The use o bi-level positive airway pressure (BiPAP) or ontin

positive airway pressure oten allows intubation to be avoide

2 !owever, intubation with assisted ventilation is sometimesneessary


15/21

Treatment

# )ronchodilators * +T routinely used" There is no consistent evid

either ' or 'adrenergic bronchodilators are of benet for the statreatment of bronchiolitis"

# -orticosteroids * +T routinely used" The ro%e o' $ort"$ostero"ds "n trebron$h"o%"t"s "s $ontro&ers"a%. No d"eren$e )as 'o(nd "n hosp"ta%"+at"on ratresp"ratory stat(s bet)een those "n'ants )ho re$e"&ed a 6>m"%%"-ram


16/21

Treatment


17/21

Comp%"$at"ons

# Comp%"$at"ons o' therapy "n$%(de the 'o%%o)"n-:

# 0ent"%ator>"nd($ed barotra(ma

# Noso$om"a% "n'e$t"on

# Beta>a-on"st2"nd($ed arrhythm"as


18/21

Adm"ss"on"s$har-e $r"ter"a# The maor"ty o' $h"%dren )"th bron$h"o%"t"s $an be d"s$har-ed 'rom

# Ass(ran$e o' an ade(ate home en&"ronment and 'o%%o)>(p $are

essent"a% 'or d"s$har-e.

# Fa$tors 'or pred"$t"n- sa'e d"s$har-e 'rom the E /See Be%o)1

# Oy-en sat(rat"on o' 58J or the "nab"%"ty to ade(ate%y 'eed anma"nta"n hydrat"on are the most $ommon reasons 'or adm"ss"on 'bron$h"o%"t"s.

# 0nfants with witnessed episodes of apnea reuire admissi

# $dmission is recommended for those with ris% factors for even when they are clinically well appearing"

# Most eperts re$ommend adm"ss"on o' a%% "n'ants 56 month o' a-test pos"t"&e 'or RS0* re-ard%ess o' se&er"ty o' symptoms* as apnede&e%op )"tho(t resp"ratory d"stress "n these pat"ents.


19/21


20/21

Fo%%o) @p

# Those $h"%dren )"th m"%d bron$h"o%"t"s )ho demonstrate no s"-"n$rease "n resp"ratory eort and are ab%e to ma"nta"n ade(a"nta


21/21

S(mmary# Bron$h"o%"t"s "s a $ommon seasona% &"ra% "n'e$t"on o' the (pper

%o)er resp"ratory tra$t* most $ommon%y seen "n $h"%dren %ess tyears.

# RS0 2 Most $ommon $a(se / others 2 adeno* para"n,(en+a*metapne(mo &"r(s1

# Presentat"on 2 0ar"ab%e and dynam"$ 'rom Rh"norrhea* ta$hypn)hee+"n- to apnea

# "a-nosed based on !nd"n-s o' the h"story and phys"$a% eaman$"%%ary tests o'ten (nne$essary

# Treatment Most%y s(pport"&e 2 Oy-en* hydrat"on

2 Bronhodilators, ortiosteroids not routinely used

# Cons"der hosp"ta%"+at"on "' pat"ent 564 )ee

bronchiolitis management

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