Acute Bronchiolitis Management

How to Use Algorithm

Scope

Does not apply if severe or atypical presentation

Inclusion Criteria

Children, 1‐12 months of age, presenting with symptoms and signs suggestive of a clinical diagnosis of bronchiolitis, such as upper respiratory tract infection such as rhinitis and coughing, progressing to lower respiratory symptoms including wheezing, crackles, and/or tachypnea that may result in difficulty breathing and/or difficulty feeding

Exclusion Criteria

• Full‐term infants that are <28 days old
• Premature infants that are <48 weeks post‐conception
• Patients with hemodynamically significant cardiac or significant pulmonary disease (such as bronchopulmonary dysplasia or asthma) or other major chronic conditions (such as immunodeficiency and neuromuscular disease)

History & Physical

1. Obtain patient's medical history
2. Complete physical exam with vital signs and pulse oximetry
3. Assess hydration status

Assess Severity

Assess severity by considering:

• Any history of apnea
• Respiratory rate
• Work of breathing
• Mental status
• Pulse oximetry
• Ability to feed/drink

Routine chest xray, viral testing, and blood or urine testing are NOT recommended The above diagnostic testing MAY be considered in the case of severe or atypical presentation or if concern for congenital or acquired heart disease

First Line Therapies

• May consider supplemental oxygen to maintain SpO₂ > 90%
• Consider nasal suctioning (if signs of nasal congestion)
• Maintain hydration status (if needed via IV or nasogastric feedings)

If Patient is stable and/or improving

Discharge home if patient meets following criteria.

Discharge Criteria (must meet all requirements)

1. O₂ saturation ≥ 90% while awake
2. No more than mild/moderate respiratory distress
3. Ability to maintain hydration
4. Ability to obtain reliable follow-up care

If patient does not meet all criteria, continue to observe and reassess.

If Patient NOT stable or improving

Consider the following adjunct therapies

• High flow nasal canula
• Nebulized epinepherine
• Manage as appropriate to clinical findings

References

1. Ralston S, Lieberthal A, Meissner H, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-502. [PubMed]