Acute Viral Bronchiolitis: A Narrative Review

Abstract

Acute viral bronchiolitis (AVB) is the leading cause of hospital admissions among infants in developed and developing countries and associated with increased morbidity and cost of treatment. This review was performed to guide the clinicians managing AVB in light of evidence accumulated in the last decade. We searched published English literature in last decade regarding etiology, diagnosis, treatment, and prevention of AVB using PubMed and Cochrane Database of Systematic Reviews. Respiratory syncytial virus is the most common causative agent. The diagnosis is mainly clinical with limited role of diagnostic investigations and chest radiographs are not routinely indicated. The management of AVB remains a challenge, as the role of various interventions is not clear. Supportive care in from of provision of heated and humidified oxygen and maintaining hydration are main interventions. The use of pulse oximetry helps to guide the administration of oxygen. Trials and systematic reviews evaluated various interventions like nebulized adrenaline, bronchodilators and hypertonic saline, corticosteroids, different modes of noninvasive ventilation (high-flow nasal cannula [HFNC], continuous positive airway pressure [CPAP], and noninvasive positive pressure ventilation [NPPV]), surfactant, heliox, chest physiotherapy, and antiviral drugs. The interventions which showed some benefits in infants and children with AVB are adrenaline and hypertonic saline nebulization, HFNC, CPAP, NIV, and surfactant. The routine administration of antibiotics, bronchodilators, corticosteroids, steam inhalation, chest physiotherapy, heliox, and antiviral drugs are not recommended.

Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study

“… 18 – 20 Patients were managed following the protocol for AVB in ER and PICU. 3 , 5 The admitted infants underwent complete blood count, renal and liver function tests, blood culture, chest radiograph (case-to-case basis), and blood gas analysis. The treatment included humidified oxygen by nasal prongs, trial of bronchodilators and/or hypertonic (3%) saline, intravenous fluids, and early initiation (within 24 hours) of enteral feeding.…”

“…In case of nonimprovement, the respiratory support was escalated to nasal continuous positive airway pressure (nCPAP), high-flow nasal cannula (HFNC), or invasive mechanical ventilation. 3 , 5 Other treatments (case-to-case basis) included antibiotics (in case of suspicion of bacterial infection), inhaled or parenteral steroids, vasoactive drugs (in presence of shock), and intravenous immunoglobulin (in cases with myocarditis). 3 , 5 The infants with respiratory failure; clinical worsening and escalation of respiratory support to HFNC/CPAP; mechanical ventilation; need of vasoactive drugs; extrapulmonary complications; and underlying comorbidity were considered for PICU transfer.…”

“… 3 , 5 Other treatments (case-to-case basis) included antibiotics (in case of suspicion of bacterial infection), inhaled or parenteral steroids, vasoactive drugs (in presence of shock), and intravenous immunoglobulin (in cases with myocarditis). 3 , 5 The infants with respiratory failure; clinical worsening and escalation of respiratory support to HFNC/CPAP; mechanical ventilation; need of vasoactive drugs; extrapulmonary complications; and underlying comorbidity were considered for PICU transfer. However, not all infants fulfilling PICU admission criteria were shifted to PICU and were managed in ER.…”

“…Acute viral bronchiolitis (AVB) is the leading cause of hospitalization among infants in developed and developing countries and associated with significant morbidity. 1 – 5 The typical presentation of AVB includes a young child presenting in the winter months with 2–4 days history of low-grade fever, nasal congestion, rhinorrhea, and symptoms of lower respiratory tract illness, including cough, tachypnea, and increased respiratory effort in form of grunting, nasal flaring, and intercostal, subcostal, or supraclavicular retractions. 4 , 5 Expiratory wheezing and inspiratory crackles may be heard on auscultation.…”

“… 1 – 5 The typical presentation of AVB includes a young child presenting in the winter months with 2–4 days history of low-grade fever, nasal congestion, rhinorrhea, and symptoms of lower respiratory tract illness, including cough, tachypnea, and increased respiratory effort in form of grunting, nasal flaring, and intercostal, subcostal, or supraclavicular retractions. 4 , 5 Expiratory wheezing and inspiratory crackles may be heard on auscultation. Several definitions of AVB have been proposed, but the term is generally applied to a first episode of wheezing in infants younger than 12 months of age.…”