1. BRONCHIOLITIS Dr Jonny Taitz, FRACP Geschn Paediatrician Sept 2003

2. 2 What is it?  Lower respiratory tract infection  Infants < 1 yr  Leads to air trapping & airway obstruction  90% RSV bronchiolitis  Most causes are self limiting

3. 3 Diagnosis  Clinical Nasal obstruction Runny nose Cough Fever cough Apnoea (particularly neonates)

4. 4 Respiratory Distress  MildClinical Signs:  Moderate  Severe  Greatest risk: Very young Prem/LBW Underlying heart/lung problems

5. 5 Respiratory Distress (contd)   RR. Very important clinical finding.  Tug/recession  Cyanosis  Flaring  Grunt

6. 6 Tests  Nil specific  Consider: NPA for respiratory viruses CXR FBC B/C NONE are routine

7. 7 Differential DX  What else can this be ?!?  Pneumonia CXR,  Fever, “toxic”  Asthma familiy hx, no fever, bronchodilator response, older children  Heart Failure  HR, murmurs, big liver  Pneumothorax CXR, deviated trachea  Foreign Body hx, choking, unilateral signs

8. 8 Management Is Respiration effective? NoYes 100% FM02- Mild Bag/mask ventilation- Moderate NETS/PICU- Severe Intubate & ventilate

9. 9 Mild Bronchiolitis  Feeding normally  Little respiratory distress  Fever less than 38 5 C (50%)  No O 2 requirements   D/C home

10. 10 Moderate Bronchiolitis  SOB, poor feeding  Moderate respiratory distress  Short, self limiting Apnoeas  Need O 2 to keep sats > 95%  Fever   admit, Paediatrician where possible  O 2, IV fluids  Observation sats NB  NPA ± CXR

11. 11 Severe Bronchiolitis  Unable to feed  Severe respiratory distress  Tiring! Frequent & prolonged Apnoea  Maximum O 2 UNABLE to keep sats up  Fever   NETS, CICU  NBM, IV fluids  CXR, NPA, ABG  Monitor, intubate, ventilate

12. 12 Issues in Bronchiolitis O2O2 Mainstay of treatment Aim for sats > 95% on initial presentation Sats > 92% on D/C  Fluids Feeds if tolerated NBM IV fluids Maintenance

13. 13 Issues in Bronchiolitis (contd)  Drugs NOT helpful Trial of bronchodilator and review Antibiotics unhelpful Antivirals Steroids  PhysioRx Contraindicated

14. 14 Issues in Bronchiolitis (contd)  Cross infection prevention  NB Nursing issues  Value of repeated regular observations critical in effective management!

15. 15 Take Home Message  O 2 is the key  Regular & repeated observation  NO role for medication  Watch out for: Prems LBW Congenital heart disease Chronic lung disease  Wide spectrum of presentations

16. 16 Questions