Viral bronchiolitis in young infants: new perspectives for management and treatment

Caballero, Mauricio T.; Polack, Fernando P.; Stein, Renato T.

doi:10.1016/j.jped.2017.07.003

Cited by 26 publications

(9 citation statements)

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“…Despite low adherence to diagnosis, and poor recording of all items relating to history and examination, adherence to appropriate symptomatic management of bronchiolitis including monitoring oxygen saturation, prescribing oxygen to maintain oxygen saturation at 93% or greater and ensuring frequent feeding either through nasogastric tube or intravenous fluid depending on the severity of symptoms (BRON20–22) was over 70% 19. Though it was beyond the scope of this study to verify whether clinicians were unsure of the appropriate diagnosis of bronchiolitis, the documented discrepancy between diagnosis and management of bronchiolitis suggest that the documentation of diagnosis was incomplete.…”

Section: Discussionmentioning

confidence: 99%

Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey

et al. 2019

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BackgroundBronchiolitis is the most common cause of respiratory hospitalisation in children aged <2 years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia.MethodsWe searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged <2 years receiving care in 2012 and 2013.ResultsPurpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some individual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4).ConclusionsThe study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.

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Section: Discussionmentioning

confidence: 99%

Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey

et al. 2019

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“…In the present investigation, the defining characteristic hypoxemia also presented high specificity, which diverged from another study (5) performed with children with respiratory infections, in which hypoxemia presented the best accuracy measures to predict the occurrence of impaired gas exchange, with sensitivity of 96.5% and specificity of 98.3%. The presence of hypoxemia in children with respiratory infection may be related to airway obstruction due to the accumulation of secretions, which may lead to changes in oxygen and carbon dioxide levels in the blood (16) . Importantly, if the airway obstruction effectively compromises gas exchange, causing changes in lung ventilation that interfere with the physiological functioning of the organism, the patient may present changes in mental state, such as restlessness, agitation, among others (16) .…”

Section: Discussionmentioning

confidence: 99%

“…The presence of hypoxemia in children with respiratory infection may be related to airway obstruction due to the accumulation of secretions, which may lead to changes in oxygen and carbon dioxide levels in the blood (16) . Importantly, if the airway obstruction effectively compromises gas exchange, causing changes in lung ventilation that interfere with the physiological functioning of the organism, the patient may present changes in mental state, such as restlessness, agitation, among others (16) . In this research, the defining characteristic restlessness presented low prevalence and high specificity.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and prevalence of defining characteristics of the diagnosis Impaired gas exchange in children

et al. 2019

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Objective: to evaluate the accuracy and to determine the prevalence of the defining characteristics of the nursing diagnosis Impaired gas exchange in children with respiratory diseases. Methods: cross-sectional study carried out with 236 children who were in the initial 48 hours of hospital admission. A questionnaire was used with sociodemographic data and physical examination of the respiratory system to identify the defining characteristics of the studied diagnosis. For the analysis of the accuracy, the sensitivity and specificity measures were calculated. Results: the diagnosis Impaired gas exchange was present in 21.6% of the sample and the most prevalent defining characteristics were dyspnea and tachycardia. Regarding the accuracy measures, the characteristics that presented high sensitivity values were dyspnea and abnormal respiratory pattern, while cyanosis, hypoxemia, and restlessness obtained high values of specificity. Conclusion: the characteristics that stood out both for the accuracy measures and for the prevalence were dyspnea and abnormal respiratory pattern. Descriptors: Respiratory Tract Infections; Data Accuracy; Nursing Diagnosis; Child. Objetivo: avaliar a acurácia e determinar a prevalência das características definidoras do diagnóstico de enfermagem Troca de gases prejudicada em crianças com doenças respiratórias. Métodos: estudo transversal realizado com 236 crianças que estavam nas 48 horas iniciais de internação hospitalar. Utilizou-se questionário com dados sociodemográficos e exame físico do sistema respiratório para identificação das características definidoras do diagnóstico estudado. Para análise da acurácia foram calculadas as medidas de sensibilidade e especificidade. Resultados: o diagnóstico Troca de gases prejudicada esteve presente em 21,6% da amostra e as características definidoras mais prevalentes foram Dispneia e Taquicardia. No que se refere às medidas de acurácia, as características que apresentaram altos valores de sensibilidade foram Dispneia e Padrão Respiratório anormal, enquanto Cianose, Hipoxemia e Inquietação obtiveram elevados valores de especificidade. Conclusão: as características que se destacaram tanto pelas medidas de acurácia quanto pela prevalência foram Dispneia e Padrão respiratório anormal. Descritores: Infecções Respiratórias; Acurácia dos Dados; Diagnóstico de Enfermagem; Criança.

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“…Ensayos clínicos recientes en adultos muestran resultados alentadores en el uso de algunos nuevos antivirales (29) . La administración de inhibidores de fusión y análogos nucleosídicos mejora la sintomatología clínica, en comparación con el placebo, sin embargo, queda el interrogante de si efectos similares son observables en niños (29) . No obstante, la profilaxis puede realizarse con palivizumab, que es un anticuerpo monoclonal contra la proteína F del VRS (9) (6) .…”

Section: Tratamiento Farmacológicounclassified

Bronquiolitis

Estrada

Vesga

Restrepo

2017

Pediatr

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Aceptado el 15 de agosto de 2017 Palabras clave:Bronquiolitis aguda virus sincitial respiratorio epidemiología microbiología solución salina hipertónica. R E S U M E NLa bronquiolitis es una enfermedad que involucra las vías respiratorias inferiores y afecta a un gran número de lactantes en el mundo. Se estima que a causa de esta enfermedad hay, anualmente, 3.4 millones de admisiones hospitalarias y 199,000 muertes en los países en vía de desarrollo. La enfermedad es más frecuente en las temporadas de lluvia y existen múltiples factores de riesgo que pueden aumentar su gravedad.El agente causal más importante de la bronquiolitis es el virus sincitial respiratorio, el cual se transmite por medio de fómites nasales. El cuadro clínico inicia con síntomas de la vía aérea superior que progresan a las vías aéreas inferiores, llegando a causar insuficiencia respiratoria como consecuencia de una alta liberación de mediadores proinflamatorios. El diagnóstico es clínico, sin embargo, se utilizan otros métodos diagnósticos cuando hay sospecha de otra patología. Diferentes terapias han sido propuestas para su manejo clínico, que se basan en medidas de sostén para el paciente, el uso de oxígeno, nebulizaciones de solución salina hipertónica, corticosteroides, antivirales, profilaxis con palivizumab y, más recientemente, el uso de sulfato de zinc.Todavía existe un considerable desconocimiento acerca de algunos aspectos relacionados con el manejo de esta enfermedad. Sin embargo, se han descubierto nuevos mecanismos fisiopatológicos que en un futuro podrían llegar a ser un blanco terapéutico. Bronchiolitis: a Current Perspective A B S T R A C TBronchiolitis is a disease that involves the lower respiratory tract and affects large numbers of nurslings worldwide. It is estimated that as a result of this disease there are, in developing countries, 3.4 million hospital admissions and 199,000 deaths per year. This disease is more frequent in rainy seasons and there are multiple risk factors which can increase its severity.The most important causal agent of bronchiolitis is the respiratory syncytial virus, which is transmitted through nasal secretions. The clinical picture begins with symptoms of the upper Keywords:Bronchiolitis respiratory syncytial viruses epidemiology hypertonic saline solution.* Autor para correspondencia. Nicolás Estrada

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Viral bronchiolitis in young infants: new perspectives for management and treatment

Abstract: A number of promising new technologies are advancing in the field. Until new interventions became feasible, early detection and modification of preventable risk factors is essential to improve outcomes.

Cited by 26 publications

References 34 publications

Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey

Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey

Accuracy and prevalence of defining characteristics of the diagnosis Impaired gas exchange in children

Bronquiolitis

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