Management of acute bronchiolitis.

Rakshi, K; Couriel, Jon

doi:10.1136/adc.71.5.463

Cited by 68 publications

(44 citation statements)

References 61 publications

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“…Bronchiolitis is usually a self-limited disease, but some children may develop respiratory failure with increased work of breathing (WOB), hypoxemia and hypercarbia requiring mechanical ventilation (MV) in addition to usual supportive measures [7,8]. Research has mostly focused on gas exchange and criteria for respiratory failure, and the efficacy of various treatments to improve gas exchange, reduce WOB, and hasten recovery [9].…”

Section: Introductionmentioning

confidence: 99%

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Cruces

González‐Dambrauskas

Quilodran³

et al. 2017

BMC Pulm Med

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Background: Analysis of respiratory mechanics during mechanical ventilation (MV) is able to estimate resistive, elastic and inertial components of the working pressure of the respiratory system. Our aim was to discriminate the components of the working pressure of the respiratory system in infants on MV with severe bronchiolitis admitted to two PICU's. Methods: Infants younger than 1 year old with acute respiratory failure caused by severe bronchiolitis underwent neuromuscular blockade, tracheal intubation and volume controlled MV. Shortly after intubation studies of pulmonary mechanics were performed using inspiratory and expiratory breath hold. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory (PIP), plateau (PPL) and total expiratory pressures (tPEEP) were measured. Inspiratory and expiratory resistances (RawI and RawE) and Time Constants (K TI and K TE ) were calculated. Results: We included 16 patients, of median age 2.5 (1-5.8) months. Bronchiolitis due to respiratory syncytial virus was the main etiology (93.8%) and 31.3% had comorbidities. Measured respiratory pressures were PIP 29 (26-31), PPL 24 (20-26), tPEEP 9 [8-11] cmH2O. Elastic component of the working pressure was significantly higher than resistive and both higher than threshold (tPEEP -PEEP) (P < 0.01). QI was significantly lower than Conclusions: Analysis of respiratory mechanics of infants with severe bronchiolitis receiving MV shows that the elastic component of the working pressure of the respiratory system is the most important. The elastic and resistive components in conjunction with flow profile are characteristic of restrictive diseases. A better understanding of lung mechanics in this group of patients may lead to change the traditional ventilatory approach to severe bronchiolitis.

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Section: Introductionmentioning

confidence: 99%

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Cruces

González‐Dambrauskas

Quilodran³

et al. 2017

BMC Pulm Med

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“…Miller et al [160,[241][242][243][244][245][246][247][248][249] listed several risk factors for severe bronchiolitis or severe RSV infection, such as age < 6 weeks at presentation, apnea, preterm birth, lung disease (e.g., chronic lung disease, cystic fibrosis), congenital heart disease, congenital or acquired immunodeficiency, multiple congenital abnormalities, and severe neurological disease. Shaw et al [34] found several predictors for identifying infants with bronchiolitis at risk for having more severe disease: ill or toxic general appearance, oxygen saturation < 95% at sea level, gestational age < 34 weeks, respiratory rate > 70/min, atelectasis on chest roentgenograms, and postnatal age < 3 months.…”

Section: Making Other Predictionsmentioning

confidence: 99%

A systematic review of predictive modeling for bronchiolitis

Luo

Nkoy

Gesteland

et al. 2014

International Journal of Medical Informatics

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Purpose: Bronchiolitis is the most common cause of illness leading to hospitalization in young children. At present, many bronchiolitis management decisions are made subjectively, leading to significant practice variation among hospitals and physicians caring for children with bronchiolitis. To standardize care for bronchiolitis, researchers have proposed various models to predict the disease course to help determine a proper management plan. This paper reviews the existing state of the art of predictive modeling for bronchiolitis. Predictive modeling for respiratory syncytial virus (RSV) infection is covered whenever appropriate, as RSV accounts for about 70% of bronchiolitis cases.Methods: A systematic review was conducted through a PubMed search up to April 25, 2014. The literature on predictive modeling for bronchiolitis was retrieved using a comprehensive search query, which was developed through an iterative process.Search results were limited to human subjects, the English language, and children (birth-18 years). Results:The literature search returned 2,312 references in total. After manual review, 168 of these references were determined to be relevant and are discussed in this paper. We identify several limitations and open problems in predictive modeling for bronchiolitis, and provide some preliminary thoughts on how to address them, with the hope to stimulate future research in this domain. Conclusions:Many problems remain open in predictive modeling for bronchiolitis. Future studies will need to address them to achieve optimal predictive models.

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“…Entretanto, o emprego judicioso de oxigênio, uma hidratação adequada, um mínimo manuseio da criança e uma precoce identificação e tratamento das complicações são fundamentais 1,6,10 . Não há dúvida, quanto a real importância desses aspectos, que se caracterizam como um ponto comum em todos os protocolos de tratamento direcionados à assistência de pacientes portadores de bronquiolite viral aguda.…”

Section: Tratamentounclassified

“…A doença ocorre mais freqüentemente em crianças de até um ano de idade [1][2][3][4][5] , sendo as apresentações mais graves nos primeiros seis meses de vida e especialmente em prematuros [6][7][8] . Constitui-se na infecção do trato respirató-rio inferior mais freqüente nessa faixa etária.…”

Section: Introductionunclassified

Acute viral bronchiolitis - still subject for controversy

Amantéa¹,

Silva²

1998

J Pediatr (Rio J)

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ResumoObjetivos: Os autores apresentam uma revisão sobre bronquiolite viral aguda, salientando os aspectos, ainda controversos, relacionados à terapêutica da doença. Além dessas questões teóricas, referidas pela literatura, procuram estabelecer um juízo crítico acerca do assunto, referindo suas posições pessoais frente ao manejo dessa doença.Métodos: Foram selecionados, a partir de uma pesquisa no banco de dados da Medline, os artigos que julgamos mais significativos acerca do tema, publicados na literatura médica nos últimos 20 anos.Resultados: Bronquiolite viral aguda é a doença infecciosa do trato respiratório inferior mais freqüente no primeiro ano de idade. Apesar da sua significativa prevalência e de todo o risco que tal situação pode conferir aos pacientes nessa faixa etária, muito pouco evoluímos acerca da terapêutica empregada nessa situação clínica. Cada vez mais encontramos fundamentada a importância de uma hidratação adequada, dos cuidados necessários para prevenir infecção cruzada e da importância da oxigenoterapia. Muitas dúvidas persistem com relação ao papel das drogas broncodilatadoras e antivirais (ribavirina). Algumas perspectivas se abrem com o emprego de imunoglobulinas específicas, principalmente na prevenção da doença pelo vírus sincicial respiratório em populações de risco. Cada vez menos, encontramos justificada, a utilização de corticosteróides na fase aguda da doença.Conclusões: Bronquiolite viral aguda é uma doença que ainda carece de um tratamento ideal. As rotinas por nós empregadas pouco mudaram nos últimos 30 anos, o que faz com que haja muita controvérsia, acerca da terapêutica a ser utilizada entre os mais diversos centros de assistência.J. pediatr. (Rio J.). 1998; 74 (Supl.1): S37-S47: bronquiolite, vírus sincicial respiratório, ribavirina, broncodilatador. AbstractObjectives: The authors review the current literature on acute viral bronchiolitis discussing the points still subject to controversy in regard to its treatment. At the same time, a personal point of view on the management of this disorder based on the authors´ experience is also expressed.Methods: The main published papers from the last twenty years were selected from a Medline database search.

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Management of acute bronchiolitis.

Cited by 68 publications

References 61 publications

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

A systematic review of predictive modeling for bronchiolitis

Acute viral bronchiolitis - still subject for controversy

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