The debate surrounding pediatric bronchiolitis
There has been much debate over how and when to treat pediatric patients who have respiratory syncytial viral bronchiolitis. Prevention is obviously the key, especially in those with multiple comorbidities. In patients with no risk factors, is it appropriate to use steroids and bronchodilators? If so, when should they be prescribed?—KRISTIE ANGUIANO, MSN, CFNP, Corpus Christi, Tex.
The National Guideline Clearinghouse provides some very good evidence-based advice for the treatment of infants with bronchiolitis: (1) Oxygen therapy is reasonable when oxygen saturation is <91% and should be weaned when it is consistently >94%. (2) Scheduled or serial use of bronchodilator-aerosol therapies is not recommended unless there is documented clinical improvement. (3) Inhalations using epinephrine as a trial therapy may be considered. (4) Any inhalation therapy that has not yielded improvement in the patient's condition within 15-20 minutes should not be repeated or continued. (5) Antibiotics are not recommended in the absence of an identified bacterial focus. (6) Antihistamines, oral decongestants, and nasal vasoconstrictors are not recommended for routine therapy. (7) Steroid therapy given as inhalations, IV, orally, or IM is not recommended because of a lack of effect on clinical status or on length of stay. These guidelines and others are available at www.guideline.gov.—Julee B. Waldrop, DNP (147-6)