From bronchiolitis guideline to practice: A critical care perspective.
Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.
James A Lin, Andranik Madikians, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mattel Children's Hospital UCLA, University of California, Los Angeles, CA 90095, United States.
James A
JA
Lin
James A Lin, Andranik Madikians, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mattel Children's Hospital UCLA, University of California, Los Angeles, CA 90095, United States.
Andranik
A
Madikians
Acute viral bronchiolitis; Asthma; Hypertonic nebulized saline; Respiratory syncytial virus; Rhinovirus