Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis

Gill, Peter; Anwar, Rashid; Kornelsen, Emily; Parkin, Patricia C.; Mahood, Quenby; Mahant, Sanjay

doi:10.1002/14651858.cd013552.pub2

Cited by 8 publications

(3 citation statements)

References 44 publications

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“…127,138 Za djecu koja toleriraju enteralno hranjenje, preporučuju se učestaliji manji obroci ili hranjenje putem oro/nazogastrične sonde. 128,[139][140][141][142] Važno je pratiti izlučivanje urina i razine elektolita u serumu, zbog mogućeg razvoja sindroma neodgovarajućeg lučenja antidiuretskog hormona (SIADH). [143][144][145][146] Respiratorna potpora pruža se postupno i u skladu s kliničkom slikom.…”

Section: Teški Bronhiolitisunclassified

Akutni bronhiolitis

2023

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Ključne riječiBRONHIOLITIS, etiologija, patogeneza, dijagnostika; KLINIČKA SLIKA; LIJEČENJE SAŽETAK. Akutni bronhiolitis infekcija je donjega dišnog sustava, zahvaća prvenstveno male dišne putove (bronhiole) te je čest uzrok bolesti i hospitalizacije dojenčadi i male djece. Po definiciji radi se o kliničkom sindromu respiratornog "distresa", koji se javlja kod djece mlađe od dvije godine, a obilježavaju ga klinički znakovi infekcije gornjega dišnog sustava (npr. rinoreja) praćeni infekcijom donjega dišnog sustava. Obično se javlja s primarnom infekcijom ili reinfekcijom virusnim patogenom. Upala bronhiola nastaje kada virusi ulaze u terminalne bronhiolarne epitelne stanice te uzrokuju njihovo izravno oštećenje i upalu. Edem sluznice, prekomjerno stvaranje sluzi i propadanje epitelnih stanica dovode do začepljenja malih dišnih putova i stvaranja atelektaza. Bronhiolitis je najčešće uzrokovan virusnom infekcijom. Iako udio infekcije određenim virusima varira ovisno o godišnjem dobu, respiratorni sincicijski virus (RSV) je najčešći uzročnik, a potom rinovirus. Manje uobičajeni uzročnici jesu redom: virus parainfluence, humani metapneumovirus, virus influence, adenovirus, koronavirus i humani bocavirus. Molekularnom dijagnostikom virusna etiologija može se potvrditi u više od 95% slučajeva. Klinički se manifestira vrućicom, kašljem i poremećajem disanja (npr. tahipneja, retrakcije interkostalnih prostora i juguluma, piskanje, auskultacijski čujne krepitacije). Često mu prethode klinički znakovi infekcije gornjega dišnog sustava, koji traju jedan do tri dana. Postavljanje dijagnoze uglavnom se temelji na anamnezi i kliničkoj slici; laboratorijska i radiološka dijagnostika pomoćne su metode, a izolacija virusa daje nam konačnu potvrdu bolesti. Trajanje i tijek akutnog bronhiolitisa ovisi o dobi djeteta, težini bolesti, stanjima vezanim uz povećani rizik (npr. nedonoščad, kronična plućna bolest) i uzročniku bolesti. Liječenje je u većini slučajeva suportivno (adekvatna hidracija, toaleta nosa i održavanje prohodnosti dišnih putova, inhalacijska terapija), a kod težih kliničkih slika pribjegava se primjeni respiratorne potpore (neinvazivne i/ili invazivne). Unatoč svemu, bronhiolitis je ipak uglavnom samoograničavajuća bolest i većini djece nije potrebna hospitalizacija te se u potpunosti oporave do 28 dana od početka simptoma bolesti.

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Section: Teški Bronhiolitisunclassified

Akutni bronhiolitis

2023

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“…Il faut aspirer les sécrétions superficielles du patient si elles sont trop abondantes et nuisent à la respiration ou à l'alimentation 1,4 . Comparativement aux liquides intraveineux, l'hydratation par sonde nasogastrique permet d'éviter la pose d'accès veineux et permet une nutrition entérale en plus de réduire l'irritabilité due à la faim 5 .…”

Section: Bronchioliteunclassified

Bronchiolite

Gill

Chanchlani

Mahant

2022

CMAJ

Self Cite

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On assiste à une résurgence des cas de bronchiolite depuis l'assouplissement des mesures de distanciation physique liées à la COVID 19La bronchiolite est une infection virale des voies respiratoires inférieures qui entraîne une inflammation et un oedème des bronchioles. Elle est habituellement causée par un virus respiratoire syncytial 1 . Avant la pandémie de COVID-19, en Ontario, 2,6 enfants de moins de 1 an sur 100 étaient amenés aux urgences pour une bronchiolite 2 . L'incidence a diminué en 2020 en raison du port du masque, des fermetures d'écoles et des mesures de distanciation physique. Toutefois, lorsque ces mesures ont été assouplies, de nombreux pays ont connu une résurgence hors saison et une augmentation des cas chez les enfants de plus de 1 an 3 .

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“…1 Recent studies demonstrate that providing early enteral nutrition for infants admitted to the hospital with respiratory distress due to bronchiolitis does not increase the risk of aspiration or other complications, including those supported with a high-flow nasal cannula (HFNC). [2][3][4][5][6][7][8][9] The literature demonstrates that enteral nutrition can decrease respiratory rate and provide apparent patient comfort by addressing irritability from hunger that compounds the existing respiratory distress. 10 Evidence supports that providing adequate nutrition early in acute illness leads to a faster recovery and significantly decreases total length of stay (LOS) for children admitted with bronchiolitis.…”

Section: Introductionmentioning

confidence: 99%

A Quality Initiative to Prioritize Enteral Feeding in Bronchiolitis

Beam,

Long,

Nicholson

et al. 2024

Pediatric Quality &Amp; Safety

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Introduction: Recent studies have identified enteral feeding as a safe alternative to intravenous fluid hydration for inpatients with bronchiolitis receiving respiratory support. Specifically, it can improve vital signs, shorten time on high-flow nasal cannula, and is associated with reduced length of stay. We aimed to increase the percentage of patients receiving enteral feeding on admission with mild-to-moderate bronchiolitis, including those on high-flow nasal cannula, from 83% to 95% within 6 months. Methods: A multidisciplinary quality improvement team identified key drivers preventing enteral feeding as lack of standardization, perception of aspiration risk, and lack of familiarity with feeding orders. PDSA cycles focused on developing and implementing a bronchiolitis clinical practice pathway with an embedded guideline and order set as decision support to prioritize enteral feeding. Additionally, educational sessions were provided for trainees and attendings who were impacted by this pathway. Results: Following interventions, initiation of enteral feeding increased (83%–96%). Additionally, intravenous line placement decreased (37%–12%) with a mirrored increase in nasogastric tube placement (4%–21%). This was associated with a shorter overall length of stay and no increased transfer rate to intensive care. Conclusions: Using quality improvement methodology to standardize enteral feeding and hydration increased the initiation rate of enteral feeding in patients admitted with bronchiolitis. These changes were seen immediately after the implementation of the clinical pathway and sustained throughout the bronchiolitis season.

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Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis

Cited by 8 publications

References 44 publications

Akutni bronhiolitis

Akutni bronhiolitis

Bronchiolite

A Quality Initiative to Prioritize Enteral Feeding in Bronchiolitis

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