BRONCHIOLITIS by kinzang

BRONCHIOLITIS.

kinyang91 — 2017-09-04 23:14:06 UTC

An inflammation of the small bronchiolar airways resulting from a viral infection.

Many viruses cause bronchiolitis. The most common viral pathogen is a respiratory syncytial virus (RSV), which accounts for 50% to 80% of all bronchiolitis cases.Other contributing viruses include para influenza types 1 and 2; adenovirus types 1, 2, and 5; influenza type B; rhinovirus; and human metapneumovirus.

AGE GROUP.

kinyang91 — 2017-09-04 23:16:19 UTC

Leading cause of hospitalizations in children younger than 1year old in the United States.
a common life-threatening complication associated with bronchiolitis is apnea, particularly in the premature, low birth weight, or young infant (less than 3 months of age).

Signs and Symptoms.

kinyang91 — 2017-09-04 23:19:30 UTC

ACUTE BRONCHIOLITIS.

acute inflammation
increased mucus production
bronchoconstriction
The initial presentation often begins with nasal congestion followed by lower-respiratory symptoms of a cough, tachypnea, wheezing, and coarse crackle

Clinical signs and symptoms of bronchiolitis

Low-grade fever
Rhinorrhea
Cough
Tachypnea, earliest sign of change in status of disease
Tachycardia
Retractions, subcostal and intercostal
Nasal flaring
Expiratory wheezing, with or without bilateral
crackles
Prolonged expiratory time
Cyanosis

Treatment Strategies

kinyang91 — 2017-09-04 23:29:27 UTC

1.Suctioning and Mucus Clearance

nasal congestion and blockage can range from a mild nuisance to a life-threatening respiratory distress.
Nasal suctioning
(acorn nasal aspirator or bulb suction because of the minimal negative pressure)and saline drops
Intermittent suction to minimize nasal trauma if higher negative pressure is used.

2. Oxygen Therapy

treatment and prevention of hypoxemia
initiate supplemental if SPO2 < 90%.

3.Helium-Oxygen (Heliox) Therapy
4.Inhaled Bronchodilator Therapy
5.Epinephrine

For airway edema

6.Hypertonic Saline Solution

For airway edema and mucous plugging.

7.Chest Physiotherapy
8.Positioning
9.Fluid Management.
10.Glucocorticoids

11.Antibiotics

12.Ribavirin (Virazole)

Ribavirin is a broad-spectrum antiviral medication used in the treatment of children with severe RSV.

Ventilator management and settings/special considerations with weaning

kinyang91 — 2017-09-04 23:31:19 UTC

1.CPAP
4 -5 cmH2O
2.BIPAP

IPAP 8-10cmH2O
EPAP 4-6cmH2O

3.Mechinical ventilation.

Normal vent setting.

Short/Long term outcomes

kinyang91 — 2017-09-04 23:32:07 UTC

For children hospitalized with acute bronchiolitis, mortality rates are less than 1% (less than 500 deaths) per year in the United States but can be as high as 600,000 in other parts of the world. Most hospitalized infants recover from acute bronchiolitis without sequelae within 3 to 4 days.
High-risk infants are hospitalized longer with a higher rate of intensive care admission and mechanical ventilation.
One study found that approximately 40% of survivors have subsequent wheezing episodes up to the age of 5 years, and 10% have subsequent wheezing episodes after 5 years. It has also been suggested that RSV in infancy is an independent risk factor for recurrent wheezing and asthma.

kinyang91 — 2017-09-04 23:40:50 UTC

Risk factors occasionally reported as associated with bronchiolitis include male gender, having older siblings, living in crowded conditions, exposure to tobacco smoke, attending day care, and low socioeconomic status