BRONCHIOLITIS

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BRONCHIOLITIS

• Dr Jonny Taitz, FRACP
• Geschn Paediatrician
• Sept 2003

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What is it?

• Lower respiratory tract infection
• Infants lt 1 yr
• Leads to air trapping airway obstruction
• 90 RSV bronchiolitis
• Most causes are self limiting

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Diagnosis

• Clinical
• Nasal obstruction
• Runny nose
• Cough
• Fever cough
• Apnoea (particularly neonates)

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Respiratory Distress

• Mild Clinical Signs
• Moderate
• Severe
• Greatest risk
• Very young
• Prem/LBW
• Underlying heart/lung problems

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Respiratory Distress (contd)

• ? RR . Very important clinical finding.
• Tug/recession
• Cyanosis
• Flaring
• Grunt

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Tests

• Nil specific
• Consider
• NPA for respiratory viruses
• CXR
• FBC
• B/C
• NONE are routine

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Differential DX

• What else can this be ?!?
• Pneumonia CXR, ? Fever, toxic
• Asthma familiy hx, no fever,
  bronchodilator response, older
  children
• Heart Failure ? HR, murmurs, big liver
• Pneumothorax CXR, deviated trachea
• Foreign Body hx, choking, unilateral signs

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Management

• Is Respiration effective?

No Yes 100 FM02 - Mild Bag/mask
ventilation - Moderate NETS/PICU -
Severe Intubate ventilate
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Mild Bronchiolitis

• Feeding normally
• Little respiratory distress
• Fever less than 385C (50)
• No O2 requirements
• ? D/C home

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Moderate Bronchiolitis

• SOB, poor feeding
• Moderate respiratory distress
• Short, self limiting Apnoeas
• Need O2 to keep sats gt 95
• Fever
• ? admit, Paediatrician where possible
• O2, IV fluids
• Observation sats NB
• NPA CXR

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Severe Bronchiolitis

• Unable to feed
• Severe respiratory distress
• Tiring! Frequent prolonged Apnoea
• Maximum O2 UNABLE to keep sats up
• Fever
• ? NETS, CICU
• NBM, IV fluids
• CXR, NPA, ABG
• Monitor, intubate, ventilate

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Issues in Bronchiolitis

• O2
• Mainstay of treatment
• Aim for sats gt 95 on initial presentation
• Sats gt 92 on D/C
• Fluids
• Feeds if tolerated
• NBM
• IV fluids
• Maintenance

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Issues in Bronchiolitis (contd)

• Drugs
• NOT helpful
• Trial of bronchodilator and review
• Antibiotics unhelpful
• Antivirals
• Steroids
• PhysioRx
• Contraindicated

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Issues in Bronchiolitis (contd)

• Cross infection prevention
• NB Nursing issues
• Value of repeated regular observations critical
  in effective management!

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Take Home Message

• O2 is the key
• Regular repeated observation
• NO role for medication
• Watch out for
• Prems
• LBW
• Congenital heart disease
• Chronic lung disease
• Wide spectrum of presentations

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Questions