Pediatrics 6: Bronchiolitis Portal
PEDS: Because this entire portal pertains only to pediatric patients, the convention of underlining has been omitted.
Bronchiolitis is an acute viral illness most commonly caused by respiratory syncytial virus (RSV). Bronchial obstruction due to edema, cellular debris, and mucus causes airway resistance to rise, resulting in wheezing, dyspnea, tachypnea, and hypoxia. Hyperinflation of the lungs with scattered consolidation in the lungs may be observed on chest x-ray. Progressive respiratory distress may result in respiratory failure with hypercapnia, uncompensated respiratory acidosis, and apnea. Monitor patients carefully. Team members should prepare to perform ventilatory assistance.
Pathophysiology
The bronchiolar obstruction due to viral-induced edema, cellular debris, and mucus results in a significant rise in airway resistance. This results in an impairment of the gases exchanged by the lung resulting in hypoxia and eventual hypercapnia.
Clinical Manifestations
Bronchiolitis occurs during the first 2 years of life with a peak incidence at 6 months of age. The child usually has a history of mild upper respiratory infection and exhibits irritability and a low-grade fever (under 102°F or 39°C). Onset of gradual respiratory distress includes wheezing, cough, and dyspnea. Rising respiratory rates may frequently exceed 60 breaths per minute and be associated with intercostal retractions and hyperinflation of the lungs. The respiratory distress may progress to respiratory failure and apnea.
Differential Diagnosis
Bronchial asthma needs to be considered but is not usually seen in children this young.
Treatment
Airway management and respiratory support may be necessary. Patients may rapidly deteriorate into respiratory failure and therefore must be carefully monitored.
Administer oxygen.
Avoid the use of sedatives.
Antibiotics are of no value for viral infections, unless you suspect a secondary bacterial infection.
Cortical steroids are not beneficial.
Nebulized albuterol is frequently used, although the beneficial effects are unknown.