Bronchiolitis - Less is More | The EM & Acute Care Course

Summary

This video discusses the impact of mask-wearing and social distancing on the reduced incidence of bronchitis in children during 2022. It delves into various treatments for bronchitis, highlighting that steroids show no significant benefit, while albuterol can help about 30% of children. The speaker also covers ineffective treatments like hypertonic saline and IV magnesium, and emphasizes the success of high-flow nasal cannula in managing the condition. The video concludes with American Academy of Pediatrics recommendations against certain treatments and the importance of managing children based on clinical assessment rather than relying solely on pulse oximetry readings.

Takeaways

• 😷 Masks and social distancing have significantly reduced bronchitis cases in children due to improved hygiene practices.
• 💊 There is no strong evidence supporting the use of oral corticosteroids in treating bronchitis in children without a diagnosis of asthma.
• 🚫 Albuterol (a bronchodilator) is commonly given to children with bronchitis, despite limited evidence of its effectiveness, and should be used cautiously.
• 🌊 Nebulized hypertonic saline has not proven effective in treating bronchitis and is not recommended.
• 🔬 A network analysis found no reliable or credible clinical benefits from various treatments such as steroids, albuterol, magnesium, and nitric oxide for bronchiolitis.
• 🌀 High-flow nasal cannula is highly effective in treating bronchiolitis, reducing the need for mechanical ventilation and improving patient comfort.
• 🛌 Proning children with severe bronchiolitis can improve respiratory effort and oxygenation, potentially delaying the need for intubation.
• 👶 The American Academy of Pediatrics recommends against routine use of albuterol, epinephrine, and systemic steroids for bronchiolitis.
• 🩺 Pulse oximetry readings should be used cautiously as they can influence admission decisions, but management should focus on the child's overall condition rather than the machine's readings.
• 🏥 Supplemental oxygen may be administered if oxyhemoglobin saturation is less than 90%, but the practice of sending children home with oxygen varies by region.

Q & A

Why is there a decrease in bronchitis cases during the COVID-19 pandemic?

The decrease in bronchitis cases is attributed to the widespread use of masks, social distancing, and increased attention to hand hygiene, which have limited the spread of respiratory viruses, including those that cause bronchitis.

What is the challenge in differentiating bronchitis from asthma in children?

Children with bronchitis often present with symptoms similar to asthma, such as wheezing and coughing. However, most asthmatics do not have a runny nose severe enough to smear it all over their face, which can be a distinguishing factor.

What does the literature review suggest about the use of oral corticosteroids in children with bronchitis?

The literature review found no significant benefit from the use of oral corticosteroids in children with bronchitis. Three out of four randomized controlled trials showed no benefit, and one suggested potential benefit only in a specific subset of patients.

Why might a child's history be considered before administering steroids for bronchitis?

If a child has a history of eczema or a family history of asthma, there is a higher chance that the child might have asthma rather than bronchitis. In such cases, steroids might be considered, although the evidence does not strongly support their use.

What is the effectiveness of albuterol in treating bronchitis in children?

A study from Connecticut Children's Hospital found that albuterol led to improvement in about 36% of the children with bronchitis who were mechanically ventilated. However, clinicians cannot reliably predict which children will respond to albuterol.

What is the role of nebulized hypertonic saline in treating bronchitis?

A study mentioned in the transcript found that hypertonic saline did not reduce hospitalization rates in children with bronchitis. Although there was some improvement in the respiratory distress scale, it did not translate into a significant clinical benefit.

What was the outcome of the study on the use of IV magnesium for bronchitis in children?

The study found no statistical difference in time to discharge, severity scores, or later clinic visits between children treated with IV magnesium and those who were not, suggesting that magnesium does not effectively treat bronchitis.

What does the American Academy of Pediatrics recommend regarding the treatment of bronchitis?

The American Academy of Pediatrics recommends against the routine use of albuterol, epinephrine, and systemic steroids for the treatment of bronchitis. They also advise against obtaining radiographic or laboratory studies routinely and suggest caution in the use of supplemental oxygen.

What is the significance of high-flow nasal cannula in the treatment of bronchitis?

High-flow nasal cannula has been shown to be effective in reducing the need for mechanical ventilation and improving comfort in children with bronchitis. It works by washing out exhaled gas and replacing it with humidified air, making it easier for the child to breathe.

What is the rationale behind proning children with severe bronchiolitis?

Proning, or placing the child face down, can improve respiratory effort and oxygenation in children with severe bronchiolitis. The position helps to open up airways and can be a useful intervention to prevent intubation.

How does the use of continuous versus intermittent pulse oximetry affect the management of bronchiolitis?

Studies have shown that there is no significant difference in length of stay or clinical outcomes between continuous and intermittent pulse oximetry. This suggests that periodic monitoring may be sufficient and can help conserve medical resources.