Acute viral bronchiolitis: Physician perspectives on definition and clinically important outcomes

Fernandes, Ricardo M; Andrade, Maria Gabriela; Constant, Carolina; Malveiro, Duarte; Ferreira-Magalhães, Manuel; Abreu, Daisy; Azevedo, Inês; Sousa, Eduarda; Salgado, Rizério; Bandeira, Teresa

doi:10.1002/ppul.23346

Cited by 17 publications

(14 citation statements)

References 31 publications

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“…Bronchiolitis, the most common lower respiratory infection in infants, continues to be a major pediatric public health problem [1,2]. Research over the past 30 years has led to significant improvement in our understanding of its pathophysiology, in identifying high-risk populations, and in attenuating the severity of the disorder [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Cruces

González‐Dambrauskas

Quilodran³

et al. 2017

BMC Pulm Med

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Background: Analysis of respiratory mechanics during mechanical ventilation (MV) is able to estimate resistive, elastic and inertial components of the working pressure of the respiratory system. Our aim was to discriminate the components of the working pressure of the respiratory system in infants on MV with severe bronchiolitis admitted to two PICU's. Methods: Infants younger than 1 year old with acute respiratory failure caused by severe bronchiolitis underwent neuromuscular blockade, tracheal intubation and volume controlled MV. Shortly after intubation studies of pulmonary mechanics were performed using inspiratory and expiratory breath hold. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory (PIP), plateau (PPL) and total expiratory pressures (tPEEP) were measured. Inspiratory and expiratory resistances (RawI and RawE) and Time Constants (K TI and K TE ) were calculated. Results: We included 16 patients, of median age 2.5 (1-5.8) months. Bronchiolitis due to respiratory syncytial virus was the main etiology (93.8%) and 31.3% had comorbidities. Measured respiratory pressures were PIP 29 (26-31), PPL 24 (20-26), tPEEP 9 [8-11] cmH2O. Elastic component of the working pressure was significantly higher than resistive and both higher than threshold (tPEEP -PEEP) (P < 0.01). QI was significantly lower than Conclusions: Analysis of respiratory mechanics of infants with severe bronchiolitis receiving MV shows that the elastic component of the working pressure of the respiratory system is the most important. The elastic and resistive components in conjunction with flow profile are characteristic of restrictive diseases. A better understanding of lung mechanics in this group of patients may lead to change the traditional ventilatory approach to severe bronchiolitis.

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Section: Introductionmentioning

confidence: 99%

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Cruces

González‐Dambrauskas

Quilodran³

et al. 2017

BMC Pulm Med

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“…These definitions generally vary in their use of wheezing or crackles or a combination of both as the prototypical examination finding in bronchiolitis (Table ). Furthermore, there is also significant variability in how individual clinician's interpret the importance of these findings for defining bronchiolitis in their clinical practice separate from published guidelines . In general, including often subtle auscultation findings, which significantly rely on operator skill and individual interpretation, in clinical guidelines is likely to introduce an additional layer of variability in the included bronchiolitis populations.…”

Section: Variable Clinical Factors Between Definitionsmentioning

confidence: 99%

The heterogeneity of viral bronchiolitis: A lack of universal consensus definitions

et al. 2017

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Viral bronchiolitis is one of the most common hospital presentations in infancy and as such represents a major healthcare burden worldwide. However despite this, there are currently no effective targeted therapies nor can those infants at highest risk for developing severe disease or subsequent respiratory morbidity be predicted on initial hospital presentation. Current definitions of bronchiolitis in the published literature vary significantly in terms of the age range at presentation, specific clinical symptoms, causative virus, and the inclusion or exclusion of infants with previous presentations and/or various comorbidities. In this review, we highlight how this heterogeneity among definitions contributes to a lack of clarity on this condition and its likely multiple endotypes. We argue that without a new universal consensus definition or sets of definitions, progress into bronchiolitis will continue to be stalled.

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“…Cangiano et al noted a higher incidence of acute bronchiolitis every 4 years among previously health term infants, largely due to RSV; rhinovirus was a less common cause and had less tendency to occur in seasonal clusters than RSV. While a commonly used standard definition for bronchiolitis is initial episode of wheezing in a child <12 months old, variability in how clinicians actually define bronchiolitis was highlighted in a report from Fernandes et al Beamer et al carried out an interesting risk factor analysis in the context of the Tucson Children's Respiratory Health Study. Spatial clustering analysis, based upon each participant's birth address, was performed for four LRI phenotypes.…”

Section: Respiratory Infectionsmentioning

confidence: 99%

Pediatric pulmonology year in review 2016: Part 2

et al. 2017

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Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review covers articles on neonatal lung disease, pulmonary physiology, and respiratory infection.Word count: 71 3

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Acute viral bronchiolitis: Physician perspectives on definition and clinically important outcomes

Cited by 17 publications

References 31 publications

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

The heterogeneity of viral bronchiolitis: A lack of universal consensus definitions

Pediatric pulmonology year in review 2016: Part 2

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