The naked emperor: that is the realm of logical fallacy

Abstract

Bronchiolitis is the most common cause of admission to hospital for infants in high-income countries.Management recommendations, based predominantly on high-quality evidence, state that the mainstays of treatment remain supportive interventions, such as oxygen therapy and hydration only.Despite evidence of no efficacy for salbutamol, adrenaline, glucocorticoids, antibiotics or chest X-ray, and repeated warnings to improve practice being published, substantial variation in practice continues. Evidence suggests use of high-flow oxygen therapy in bronchiolitis does not decrease length of hospitalization and rates of intensive care unit admission or intubation. High-flow oxygen should be limited to rescue therapy after failure of conventional nasal oxygen only in infants who are hypoxic.Reducing the use of inappropriate health interventions is important for minimizing patient harm, maximizing resources, and improving evidence-based health care delivery. Despite international clinical guidelines promoting supportive rather than interventional therapy, universal de-M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n implementation of interventional care in bronchiolitis has not occurred and remains a major challenge.