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From bronchiolitis guideline to practice: A critical care perspective
James A Lin1, Andranik Madikians1
1James 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.
Insights
Acute viral bronchiolitis, a common cause of pediatric intensive care admissions, requires individualized treatment due to limited research. Airway clearance techniques may benefit infants with atelectasis, while future research could guide bronchodilator use.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Viral Infections
Background:
- Acute viral bronchiolitis is a primary reason for pediatric intensive care unit (PICU) admissions.
- Limited research exists on managing critically ill infants with this condition.
Purpose of the Study:
- To review current understanding and potential interventions for acute viral bronchiolitis in critically ill infants.
- To highlight the need for evidence-based guidelines in pediatric critical care for this common illness.
Main Methods:
- Pathological review of viral bronchiolitis to understand airway obstruction mechanisms.
- Clinical evidence synthesis to evaluate potential therapeutic benefits.
- Discussion of diagnostic and respiratory technologies.
Main Results:
- Respiratory obstruction in bronchiolitis involves intraluminal debris and airway edema.
- Airway clearance interventions like hypertonic saline and pulmonary toilet may aid infants with atelectasis.
- Distinguishing asthma predisposition could inform bronchodilator therapy decisions.
Conclusions:
- Critical care for pediatric viral bronchiolitis heavily relies on individualized, bedside clinical assessments.
- Advancements in diagnostic and respiratory technologies promise improved support for these infants.
- Further research is needed to establish specific treatment protocols.
Abstract:
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.
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