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Bronchiolitis is a common viral illness. It is most commonly caused by respiratory syncytial virus and typically occurs over the late fall and winter months. Children less than 2 years of age are most commonly affected, with the largest burden of illness being in children less than 12 months of age.

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Key Resources English (1) French (1) All (2)

Bottom Line Recommendations: Bronchiolitis

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Plint, A & TREKK Network

Bottom line recommendations for the treatment and management of bronchiolitis. Posted online: January 14, 2021, Version 3.0.

Recommandations de Base: La Bronchiolite

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Plint, A & TREKK Network

Bottom line recommendations for the treatment and management of bronchiolitis - en francais.  Published online: January 14, 2021, Version 3.0.

Bottom Line Recommendations: Bronchiolitis

Download

Plint, A & TREKK Network

Bottom line recommendations for the treatment and management of bronchiolitis. Posted online: January 14, 2021, Version 3.0.

Recommandations de Base: La Bronchiolite

Download

Plint, A & TREKK Network

Bottom line recommendations for the treatment and management of bronchiolitis - en francais.  Published online: January 14, 2021, Version 3.0.

Clinical guidelines English (4) French All (4)

Clinical Guideline: Australasian bronchiolitis guideline

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PREDICT Network: OBrien S, Borland ML, Cotterell E, Armstrong D, Babl Franz, ...

Objective: to align and improve the consistency of the management of bronchiolitis, an evidence-based guideline was developed for the Australasian population.

Clinical Guideline: Bronchiolitis in children: diagnosis and management

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NICE guideline (NG9)

Objective: to help healthcare professionals diagnose bronchiolitis and identify if children should be cared for at home or in hospital. It describes treatments and interventions that can be used to help with the symptoms of bronchiolitis.

Clinical Guideline: Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis

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Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, J...

This guideline is a revision of the clinical practice guideline, Diagnosis and Management of Bronchiolitis, published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation.

Clinical Guideline: Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age

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Canadian Paediatric Society

The goals of this statement are to build on the comprehensive peer-reviewed AAP statement by incorporating new evidence published over the past eight years, while providing the clinician with recommendations to help guide diagnosis, monitoring and management of previously healthy children one to 24 months of age who present with signs of bronchiolitis.

Clinical Guideline: Australasian bronchiolitis guideline

Visit

PREDICT Network: OBrien S, Borland ML, Cotterell E, Armstrong D, Babl Franz, ...

Objective: to align and improve the consistency of the management of bronchiolitis, an evidence-based guideline was developed for the Australasian population.

Clinical Guideline: Bronchiolitis in children: diagnosis and management

Download

NICE guideline (NG9)

Objective: to help healthcare professionals diagnose bronchiolitis and identify if children should be cared for at home or in hospital. It describes treatments and interventions that can be used to help with the symptoms of bronchiolitis.

Clinical Guideline: Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis

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Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, J...

This guideline is a revision of the clinical practice guideline, Diagnosis and Management of Bronchiolitis, published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation.

Clinical Guideline: Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age

Visit

Canadian Paediatric Society

The goals of this statement are to build on the comprehensive peer-reviewed AAP statement by incorporating new evidence published over the past eight years, while providing the clinician with recommendations to help guide diagnosis, monitoring and management of previously healthy children one to 24 months of age who present with signs of bronchiolitis.

Overviews of systematic reviews English (8) French All (8)

Overview of Systematic Reviews: Evidence Summary: Bronchiolitis

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Alberta Research Centre for Health Evidence (ARCHE)

Evidence summary for the treatment and management of bronchiolitis.

Cochrane Summary: Antibiotics for bronchiolitis in children under two years of age

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Farley R, Spurling GK, Eriksson L, Del Mar CB

This review summarizes evidence on the effect of antibiotics on clinical outcomes in children with bronchiolitis.

Cochrane Summary: Bronchodilators for bronchiolitis for infants with first-time wheezing

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Gadomski AM, Scribani MB

This review summarizes the evidence about the effect of bronchodilators in infants with bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: An overview of reviews

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Fernandes RM, Oleszczuk M, Woods CR, Rowe BH, Cates CJ, Hartling L.

Objective: To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (<2 weeks) corticosteroid use based on systematic reviews of acute respiratory conditions.

Cochrane Summary: Hypertonic saline solution administered via nebuliser for acute bronchiolitis in infants

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Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Cochrane Summary: Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

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Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and the treatment of bronchiolitis in children: An overview of reviews

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Bialy L, Foisy M, Smith M, Fernandes RM

This updated overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the effectiveness and safety of 11 pharmacologic and non-pharmacologic treatments to improve bronchiolitis symptoms in outpatient, inpatient and intensive care populations.

Cochrane Summary: Epinephrine for acute viral bronchiolitis in children less than two years of age

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Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Overview of Systematic Reviews: Evidence Summary: Bronchiolitis

Download

Alberta Research Centre for Health Evidence (ARCHE)

Evidence summary for the treatment and management of bronchiolitis.

Cochrane Summary: Antibiotics for bronchiolitis in children under two years of age

Visit

Farley R, Spurling GK, Eriksson L, Del Mar CB

This review summarizes evidence on the effect of antibiotics on clinical outcomes in children with bronchiolitis.

Cochrane Summary: Bronchodilators for bronchiolitis for infants with first-time wheezing

Visit

Gadomski AM, Scribani MB

This review summarizes the evidence about the effect of bronchodilators in infants with bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: An overview of reviews

Visit

Fernandes RM, Oleszczuk M, Woods CR, Rowe BH, Cates CJ, Hartling L.

Objective: To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (<2 weeks) corticosteroid use based on systematic reviews of acute respiratory conditions.

Cochrane Summary: Hypertonic saline solution administered via nebuliser for acute bronchiolitis in infants

Visit

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Cochrane Summary: Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

Visit

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Overview of Systematic Reviews: The Cochrane Library and the treatment of bronchiolitis in children: An overview of reviews

Visit

Bialy L, Foisy M, Smith M, Fernandes RM

This updated overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the effectiveness and safety of 11 pharmacologic and non-pharmacologic treatments to improve bronchiolitis symptoms in outpatient, inpatient and intensive care populations.

Cochrane Summary: Epinephrine for acute viral bronchiolitis in children less than two years of age

Visit

Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Systematic reviews English (16) French All (16)

Meta-analysis: Efficacy of salbutamol in the treatment of infants with bronchiolitis: a meta-analysis of 13 studies

Visit

Cai Z, Lin Y, Liang J

Objective: To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis.

Systematic review: High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis

Visit

Lin, J. Z., Y.; Xiong, L.; Liu, S.; Gong, C.; Dai, J.

Objective: To determine whether treatment with CNHD is more effective than other non-invasive forms of treatment in pediatric patients who require respiratory support.

Cochrane Systematic Review: Continuous positive airway pressure (CPAP) for acute bronchiolitis in children

Visit

KR Jat, JL Mathew

Objective: To assess the efficacy and safety of CPAP compared to no or sham CPAP in infants and children under three years of age with acute bronchiolitis.

Meta-analysis: Association of diagnostic criteria with urinary tract infection prevalence in bronchiolitis: a systematic review and meta-analysis

Visit

McDaniel C, Ralston S, Lucas B, Schroeder AR

Objective: To conduct a systematic review and meta-analysis examining the prevalence of UTI in infants with bronchiolitis when positive UA results are incorporated into the UTI definition.

Meta-analysis: Hypertonic saline in bronchiolitis and type 1 error: a trial sequential analysis

Visit

Harrison W, Angoulvant F, House S, Gajdos V, Ralston SL

Objective: to use TSA to determine if the existing literature base is sufficient to draw firm conclusions about the effectiveness of HS in bronchiolitis.

Cochrane Systematic Review: Nebulised hypertonic saline solution for acute bronchiolitis in infants

Visit

Zhang L, Mendoza-Sassi RA, Wainwright C,Klassen TP

Objective: to assess the effects of nebulizing hypertonic saline ( 3%) in infants with acute bronchiolitis.

Systematic Review: Nebulized hypertonic saline for acute bronchiolitis: A systematic review

Visit

Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C.

Objective: The objective of this study was to assess the efficacy and safety of nebulized hypertonic saline (HS) in infants with acute bronchiolitis.

Cochrane Systematic Review: Heliox inhalation therapy for bronchiolitis in infants

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Liet JM, Ducruet T, Gupta V, Cambonie G

Objective: To assess heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores).

Systematic Review: Antibiotics for bronchiolitis in children under two years of age

Visit

Farley R, Spurling GK, Eriksson L, Del Mar CB

Objective: to evaluate the effectiveness of antibiotics for bronchiolitis in children under two years of age compared to placebo or other interventions.

Systematic Review: Bronchodilators for bronchiolitis

Visit

Gadomski AM, Scribani MB

Objective: to assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis.

Cochrane Systematic Review: Bronchodilators for bronchiolitis

Visit

Gadomski AM, Scribani MB

Objective: To assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis.

Systematic Review: Glucocorticoids for acute viral bronchiolitis in infants and young children

Visit

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Systematic Review: Nebulised hypertonic saline solution for acute bronchiolitis in infants

Visit

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Cochrane Systematic Review: Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

Visit

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: To review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Systematic Review: Epinephrine for bronchiolitis

Visit

Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Systematic Review: Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis

Visit

Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, Klassen TP, V...

Objectives: to evaluate and compare the efficacy and safety of bronchodilators and steroids, alone or combined, for the acute management of bronchiolitis in children aged less than 2 years.

Meta-analysis: Efficacy of salbutamol in the treatment of infants with bronchiolitis: a meta-analysis of 13 studies

Visit

Cai Z, Lin Y, Liang J

Objective: To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis.

Systematic review: High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis

Visit

Lin, J. Z., Y.; Xiong, L.; Liu, S.; Gong, C.; Dai, J.

Objective: To determine whether treatment with CNHD is more effective than other non-invasive forms of treatment in pediatric patients who require respiratory support.

Cochrane Systematic Review: Continuous positive airway pressure (CPAP) for acute bronchiolitis in children

Visit

KR Jat, JL Mathew

Objective: To assess the efficacy and safety of CPAP compared to no or sham CPAP in infants and children under three years of age with acute bronchiolitis.

Meta-analysis: Association of diagnostic criteria with urinary tract infection prevalence in bronchiolitis: a systematic review and meta-analysis

Visit

McDaniel C, Ralston S, Lucas B, Schroeder AR

Objective: To conduct a systematic review and meta-analysis examining the prevalence of UTI in infants with bronchiolitis when positive UA results are incorporated into the UTI definition.

Meta-analysis: Hypertonic saline in bronchiolitis and type 1 error: a trial sequential analysis

Visit

Harrison W, Angoulvant F, House S, Gajdos V, Ralston SL

Objective: to use TSA to determine if the existing literature base is sufficient to draw firm conclusions about the effectiveness of HS in bronchiolitis.

Cochrane Systematic Review: Nebulised hypertonic saline solution for acute bronchiolitis in infants

Visit

Zhang L, Mendoza-Sassi RA, Wainwright C,Klassen TP

Objective: to assess the effects of nebulizing hypertonic saline ( 3%) in infants with acute bronchiolitis.

Systematic Review: Nebulized hypertonic saline for acute bronchiolitis: A systematic review

Visit

Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C.

Objective: The objective of this study was to assess the efficacy and safety of nebulized hypertonic saline (HS) in infants with acute bronchiolitis.

Cochrane Systematic Review: Heliox inhalation therapy for bronchiolitis in infants

Visit

Liet JM, Ducruet T, Gupta V, Cambonie G

Objective: To assess heliox inhalation therapy in addition to standard medical care for acute bronchiolitis in infants with respiratory distress, as measured by clinical endpoints (in particular the rate of endotracheal intubation, the rate of emergency department discharge, the length of treatment for respiratory distress) and pulmonary function testing (mainly clinical respiratory scores).

Systematic Review: Antibiotics for bronchiolitis in children under two years of age

Visit

Farley R, Spurling GK, Eriksson L, Del Mar CB

Objective: to evaluate the effectiveness of antibiotics for bronchiolitis in children under two years of age compared to placebo or other interventions.

Systematic Review: Bronchodilators for bronchiolitis

Visit

Gadomski AM, Scribani MB

Objective: to assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis.

Cochrane Systematic Review: Bronchodilators for bronchiolitis

Visit

Gadomski AM, Scribani MB

Objective: To assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis.

Systematic Review: Glucocorticoids for acute viral bronchiolitis in infants and young children

Visit

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: to review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Systematic Review: Nebulised hypertonic saline solution for acute bronchiolitis in infants

Visit

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP

Objective: to assess the effects of nebulised hypertonic ( 3%) saline solution in infants with acute viral bronchiolitis.

Cochrane Systematic Review: Glucocorticoids for acute viral bronchiolitis in infants and young children under two years of age

Visit

Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson ...

Objective: To review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis.

Systematic Review: Epinephrine for bronchiolitis

Visit

Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen...

Objective: to examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis.

Systematic Review: Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis

Visit

Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, Klassen TP, V...

Objectives: to evaluate and compare the efficacy and safety of bronchodilators and steroids, alone or combined, for the acute management of bronchiolitis in children aged less than 2 years.

Key studies English (24) French All (24)

Key Study: Association of Fluid Overload with Clinical Outcomes in Critically Ill Children with Bronchiolitis: Bronquiolitis en la Unidad de Cuidados Intensivos Pediatricos (BRUCIP) Study*

Visit

Flores-Gonzalez, J. C. V., C. M.; Yun Castilla, C.; Mayordomo-Colunga, J.; Qu...

Objective: To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis.

Key Study: [Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? A randomized controlled trial]

Visit

Seliem, W and Sultan, AM

Objective: To evaluate whether the use of heliox (79:21) delivered through a low flow nasal cannula would improve respiratory distress in infants with acute bronchiolitis caused by respiratory syncytial virus.

Key Study: Chest radiography in children hospitalized with bronchiolitis

Visit

Wrotek A, Czajkowska M, Jackowska T

Objective: to evaluate the use of CR in children with bronchiolitis due to a lower respiratory tract infection (RSV-RTI) with respiratory syncytial virus (RSV) and the influence of CR on patient treatment during the 2010-2017 seasons.

Key Study: A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

Visit

Franklin, D. B., F. E.; Schlapbach, L. J.; Oakley, E.; Craig, S.; Neutze, J.;...

Objective: To assess efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs).

Key Study: Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

Visit

Seliem, W. S., A. M.

Objective: to evaluate the hypothesis that use of heliox would result in improvement of gas exchange when used with high flow nasal cannula in infants with RSV acute bronchiolitis.

Key Study: Predicting escalated care in infants with bronchiolitis

Visit

Freire

Objective: to identify predictors of "escalated care" in bronchiolitis.

Key Study: Predictors of critical care and mortality in bronchiolitis after emergency department discharge

Visit

Schuh S, Kwong J, Holder L, Graves E, Macdonald E, Finkelstein Y

Objectives:To identify the epidemiologic predictors and stratify the risk of critical care unit (CCU) admission or death in bronchiolitis following emergency department discharge. This information has not yet been explored.

Key Study: Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis

Visit

Biagi C, Pierantoni L, Baldazzi M, Greco L, Dormi A, Dondi A, Faldella G, Lan...

Objective: to assess the diagnostic accuracy and reliability of LUS for the detection of pneumonia in hospitalized children with bronchiolitis and to evaluate the agreement between LUS and CXR in diagnosing pneumonia in these patients.

Key Study: High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): An open, phase 4, randomised controlled trial

Visit

Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, Goddar...

Objectives: Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has not been rigorously studied in randomised trials. This study aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen

Key Study: Effect of nebulized hypertonic saline treatment in emergenc departments on hospitalization rate for acute bronchiolitis: a randomized clinical trial

Visit

Angoulvant F, Belletre X, Milcent K, et al

Objective: To examine whether HS nebulization treatment would decrease the hospital admission rate among infants with a first episode of acute bronchiolitis.

Key Study: High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study)

Visit

Milsi C, Essouri S, Pouyau R, Liet JM, Afanetti M, Portefaix A, Baleine J,Dur...

Objective: To assess oxygen delivery via high flow nasal cannula (HFNC).

Key Study: Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis

Visit

Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S

Objective: To examine whether there is a difference in the proportion of unscheduled medical visits within 72 hours of emergency department discharge in infants with bronchiolitis who have oxygen desaturations to lower than 90% for at least 1 minute during home oximetry monitoring vs those without desaturations.

Key Study: Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis

Visit

Schreiber S, Ronfani L, Ghirardo S, Minen F, Taddio A, Jaber M, Rizzello E, B...

Objective: To compare nasal irrigation using either isotonic 0.9% sodium chloride or hypertonic 3% sodium chloride with simple supportive care in infants with bronchiolitis.

Key Study: Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized controlled trial

Visit

McCulloh R, Koster M, Ralston S, Johnson M, Hill V, Koehn K, Weddle G, Alvers...

Objective: To determine the effect of intermittent vs continuous pulse oximetry monitoring on hospital length of stay among nonhypoxemic infants and young children hospitalized for bronchiolitis.

Key Study: Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial

Visit

Flores-Gonzlez JC, Matamala-Morillo MA, Rodrguez-Campoy P, Prez-Guerrero JJ, ...

Objective: To evaluate the efficacy of nebulized epinephrine in 3% hypertonic saline.

Key Study: Bronchiolitis of Infancy Discharge Study (BIDS): a multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation

Visit

Cunningham S, Rodriguez A, Boyd KA, McIntosh E, Lewis SC, BIDS Collaborators ...

Objective: To compare the American Academy of Pediatrics guideline target of SpO2 90% with the Scottish Intercollegiate Guidelines Network target of SpO2 94%.

Key Study: Nebulised hypertonic saline (3%) among children with mild to moderately severe bronchiolitis--a double blind randomized controlled trial

Visit

Khanal A, Sharma A, Basnet S, Sharma PR, Gami FC

Objective: To Assess the efficacy of nebulised hypertonic saline (HS) (3%) among children with mild to moderately severe bronchiolitis.

Key Study: Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial

Visit

Schuh S, Freedman S, Coates A, Allen U, Parkin P, Stephens D, Ungar W, DaSilv...

Objective: To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed.

Key Study: Nasogastric hydration vs intravenous hydration for infants with bronchiolitis: a randomised trial

Visit

Oakley Ed, Borland M, () Babl F

Objective: to assess whether intravenous hydration or nasogastric hydration is better for treatment of infants.

Key Study: Epinephrine and dexamethasone in children with bronchiolitis

Visit

Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, Mitton C, Gouin S...

This randomized, double-blind, placebo-controlled, clinical trial with a factorial design at multiple sites was undertaken to determine whether treatment with nebulized epinephrine, a short course of oral dexamethasone, or both resulted in a clinically important decrease in hospital admissions among infants with bronchiolitis who were seen in the emergency department.

Key Study: A cost-effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis

Visit

Yong JHE, Schuh S, Rashidi R, Vanderby S, Lau R, Laporte A, Nauenberg E, Unga...

Objective:To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis.

Key Study: A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis

Visit

Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD, Ruddy RM, Mal...

The goal of this study was to determine the effectiveness of a single dose of oral dexamethasone in infants with moderate-to-severe bronchiolitis.

Key Study: Evaluation of the utility of radiography in acute bronchiolitis

Visit

Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, MacPhee S, Mokansk...

Objectives: to determine the proportion of radiographs inconsistent with bronchiolitis in children with typical presentation of bronchiolitis and to compare rates of intended antibiotic therapy before radiography versus those given antibiotics after radiography.

Key Study: Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections

Visit

Levine DA, Platt SL, Dayan PS, Macias CG, Zorc JJ, Krief W, Schor J, Bank D, ...

Objective: to determine the risk of SBI in young febrile infants who are infected with RSV compared with those without RSV infections.

Key Study: Association of Fluid Overload with Clinical Outcomes in Critically Ill Children with Bronchiolitis: Bronquiolitis en la Unidad de Cuidados Intensivos Pediatricos (BRUCIP) Study*

Visit

Flores-Gonzalez, J. C. V., C. M.; Yun Castilla, C.; Mayordomo-Colunga, J.; Qu...

Objective: To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis.

Key Study: [Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? A randomized controlled trial]

Visit

Seliem, W and Sultan, AM

Objective: To evaluate whether the use of heliox (79:21) delivered through a low flow nasal cannula would improve respiratory distress in infants with acute bronchiolitis caused by respiratory syncytial virus.

Key Study: Chest radiography in children hospitalized with bronchiolitis

Visit

Wrotek A, Czajkowska M, Jackowska T

Objective: to evaluate the use of CR in children with bronchiolitis due to a lower respiratory tract infection (RSV-RTI) with respiratory syncytial virus (RSV) and the influence of CR on patient treatment during the 2010-2017 seasons.

Key Study: A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

Visit

Franklin, D. B., F. E.; Schlapbach, L. J.; Oakley, E.; Craig, S.; Neutze, J.;...

Objective: To assess efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs).

Key Study: Heliox delivered by high flow nasal cannula improves oxygenation in infants with respiratory syncytial virus acute bronchiolitis

Visit

Seliem, W. S., A. M.

Objective: to evaluate the hypothesis that use of heliox would result in improvement of gas exchange when used with high flow nasal cannula in infants with RSV acute bronchiolitis.

Key Study: Predicting escalated care in infants with bronchiolitis

Visit

Freire

Objective: to identify predictors of "escalated care" in bronchiolitis.

Key Study: Predictors of critical care and mortality in bronchiolitis after emergency department discharge

Visit

Schuh S, Kwong J, Holder L, Graves E, Macdonald E, Finkelstein Y

Objectives:To identify the epidemiologic predictors and stratify the risk of critical care unit (CCU) admission or death in bronchiolitis following emergency department discharge. This information has not yet been explored.

Key Study: Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis

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Biagi C, Pierantoni L, Baldazzi M, Greco L, Dormi A, Dondi A, Faldella G, Lan...

Objective: to assess the diagnostic accuracy and reliability of LUS for the detection of pneumonia in hospitalized children with bronchiolitis and to evaluate the agreement between LUS and CXR in diagnosing pneumonia in these patients.

Key Study: High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): An open, phase 4, randomised controlled trial

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Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, Goddar...

Objectives: Bronchiolitis is the most common lung infection in infants and treatment focuses on management of respiratory distress and hypoxia. High-flow warm humidified oxygen (HFWHO) is increasingly used, but has not been rigorously studied in randomised trials. This study aimed to examine whether HFWHO provided enhanced respiratory support, thereby shortening time to weaning off oxygen

Key Study: Effect of nebulized hypertonic saline treatment in emergenc departments on hospitalization rate for acute bronchiolitis: a randomized clinical trial

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Angoulvant F, Belletre X, Milcent K, et al

Objective: To examine whether HS nebulization treatment would decrease the hospital admission rate among infants with a first episode of acute bronchiolitis.

Key Study: High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study)

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Milsi C, Essouri S, Pouyau R, Liet JM, Afanetti M, Portefaix A, Baleine J,Dur...

Objective: To assess oxygen delivery via high flow nasal cannula (HFNC).

Key Study: Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis

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Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S

Objective: To examine whether there is a difference in the proportion of unscheduled medical visits within 72 hours of emergency department discharge in infants with bronchiolitis who have oxygen desaturations to lower than 90% for at least 1 minute during home oximetry monitoring vs those without desaturations.

Key Study: Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis

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Schreiber S, Ronfani L, Ghirardo S, Minen F, Taddio A, Jaber M, Rizzello E, B...

Objective: To compare nasal irrigation using either isotonic 0.9% sodium chloride or hypertonic 3% sodium chloride with simple supportive care in infants with bronchiolitis.

Key Study: Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized controlled trial

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McCulloh R, Koster M, Ralston S, Johnson M, Hill V, Koehn K, Weddle G, Alvers...

Objective: To determine the effect of intermittent vs continuous pulse oximetry monitoring on hospital length of stay among nonhypoxemic infants and young children hospitalized for bronchiolitis.

Key Study: Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial

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Flores-Gonzlez JC, Matamala-Morillo MA, Rodrguez-Campoy P, Prez-Guerrero JJ, ...

Objective: To evaluate the efficacy of nebulized epinephrine in 3% hypertonic saline.

Key Study: Bronchiolitis of Infancy Discharge Study (BIDS): a multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation

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Cunningham S, Rodriguez A, Boyd KA, McIntosh E, Lewis SC, BIDS Collaborators ...

Objective: To compare the American Academy of Pediatrics guideline target of SpO2 90% with the Scottish Intercollegiate Guidelines Network target of SpO2 94%.

Key Study: Nebulised hypertonic saline (3%) among children with mild to moderately severe bronchiolitis--a double blind randomized controlled trial

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Khanal A, Sharma A, Basnet S, Sharma PR, Gami FC

Objective: To Assess the efficacy of nebulised hypertonic saline (HS) (3%) among children with mild to moderately severe bronchiolitis.

Key Study: Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial

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Schuh S, Freedman S, Coates A, Allen U, Parkin P, Stephens D, Ungar W, DaSilv...

Objective: To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed.

Key Study: Nasogastric hydration vs intravenous hydration for infants with bronchiolitis: a randomised trial

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Oakley Ed, Borland M, () Babl F

Objective: to assess whether intravenous hydration or nasogastric hydration is better for treatment of infants.

Key Study: Epinephrine and dexamethasone in children with bronchiolitis

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Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, Mitton C, Gouin S...

This randomized, double-blind, placebo-controlled, clinical trial with a factorial design at multiple sites was undertaken to determine whether treatment with nebulized epinephrine, a short course of oral dexamethasone, or both resulted in a clinically important decrease in hospital admissions among infants with bronchiolitis who were seen in the emergency department.

Key Study: A cost-effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis

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Yong JHE, Schuh S, Rashidi R, Vanderby S, Lau R, Laporte A, Nauenberg E, Unga...

Objective:To carry out a cost-effectiveness analysis of omitting chest radiography in the diagnosis of infant bronchiolitis.

Key Study: A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis

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Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD, Ruddy RM, Mal...

The goal of this study was to determine the effectiveness of a single dose of oral dexamethasone in infants with moderate-to-severe bronchiolitis.

Key Study: Evaluation of the utility of radiography in acute bronchiolitis

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Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, MacPhee S, Mokansk...

Objectives: to determine the proportion of radiographs inconsistent with bronchiolitis in children with typical presentation of bronchiolitis and to compare rates of intended antibiotic therapy before radiography versus those given antibiotics after radiography.

Key Study: Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections

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Levine DA, Platt SL, Dayan PS, Macias CG, Zorc JJ, Krief W, Schor J, Bank D, ...

Objective: to determine the risk of SBI in young febrile infants who are infected with RSV compared with those without RSV infections.

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What to do when your child has a cold and is having difficulty breathing

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Bronchiolitis is a viral infection, commonly caused by respiratory syncytial virus (RSV), that affects the lower part of the lungs. It mainly affects babies and young children under 2 and is very contagious. This infographic provides information on the symptoms of bronchiolitis, how to manage it at home, and when to seek emergency care.

This infographic was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

VIDEO: Cough, Cold, and Wheeze: How to help manage your childs bronchiolitis

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Bronchiolitis is a viral infection, commonly caused by respiratory syncytial virus (RSV), that affects the lower part of the lungs. It mainly affects babies and young children under 2 and is very contagious. This video provides information on the symptoms of bronchiolitis, how to manage it at home, and when to seek emergency care.

This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

More than just a cold: what to do when your child has a cold and is having difficulty breathing

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Bronchiolitis is a viral infection, commonly caused by respiratory syncytial virus (RSV), that affects the lower part of the lungs. It mainly affects babies and young children under 2 and is very contagious. This eBook provides information on the symptoms of bronchiolitis, how to manage it at home, and when to seek emergency care.

This eBook was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Emergency Medicine Cases Podcast: Bronchiolitis

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Dr. Dennis Scolnik & Dr. Sanjay Mehta

Episode 59:This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses made in both general and pediatric EDs, and like many pediatric illnesses, theres a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes its difficult to predict which kids will do well and which kids wont.With the help of Dr. Dennis Scolnik, the clinical fellowship program director at Torontos only pediatric emergency department and Dr. Sanjay Mehta, an amazing educator who you might remember from his fantastic work on our Pediatric Ortho episode, well sort through how to assess the child with respiratory illness, how to predict which kids might run into trouble, and what the best evidence-based management of these kids is. 

Emergency Medicine Cases Podcast: Bronchiolitis Part 2

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Dr. Amy Plint

Episode 59B: In response to Episode 59 with Dr. Sanjay Mehta and Dr. Dennis Scolnik on the emergency department diagnosis and management of Bronchiolitis, Dr. Amy Plint, one of Canadas most prominent researchers in Bronchiolitis and the Chair of Pediatric Emergency Research Canada, tells her practical approach to choosing medications in the emergency department, the take home message from her landmark 2009 NEJM study on the use of nebulized epinephrine and dexamethasone for treating Bronchiolitis, and the future of Bronchiolitis research. Published online: February 2015 

What to do when your child has a cold and is having difficulty breathing

Visit

Bronchiolitis is a viral infection, commonly caused by respiratory syncytial virus (RSV), that affects the lower part of the lungs. It mainly affects babies and young children under 2 and is very contagious. This infographic provides information on the symptoms of bronchiolitis, how to manage it at home, and when to seek emergency care.

This infographic was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

VIDEO: Cough, Cold, and Wheeze: How to help manage your childs bronchiolitis

Visit

Bronchiolitis is a viral infection, commonly caused by respiratory syncytial virus (RSV), that affects the lower part of the lungs. It mainly affects babies and young children under 2 and is very contagious. This video provides information on the symptoms of bronchiolitis, how to manage it at home, and when to seek emergency care.

This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

More than just a cold: what to do when your child has a cold and is having difficulty breathing

Download

Bronchiolitis is a viral infection, commonly caused by respiratory syncytial virus (RSV), that affects the lower part of the lungs. It mainly affects babies and young children under 2 and is very contagious. This eBook provides information on the symptoms of bronchiolitis, how to manage it at home, and when to seek emergency care.

This eBook was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Emergency Medicine Cases Podcast: Bronchiolitis

Visit

Dr. Dennis Scolnik & Dr. Sanjay Mehta

Episode 59:This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses made in both general and pediatric EDs, and like many pediatric illnesses, theres a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes its difficult to predict which kids will do well and which kids wont.With the help of Dr. Dennis Scolnik, the clinical fellowship program director at Torontos only pediatric emergency department and Dr. Sanjay Mehta, an amazing educator who you might remember from his fantastic work on our Pediatric Ortho episode, well sort through how to assess the child with respiratory illness, how to predict which kids might run into trouble, and what the best evidence-based management of these kids is. 

Emergency Medicine Cases Podcast: Bronchiolitis Part 2

Visit

Dr. Amy Plint

Episode 59B: In response to Episode 59 with Dr. Sanjay Mehta and Dr. Dennis Scolnik on the emergency department diagnosis and management of Bronchiolitis, Dr. Amy Plint, one of Canadas most prominent researchers in Bronchiolitis and the Chair of Pediatric Emergency Research Canada, tells her practical approach to choosing medications in the emergency department, the take home message from her landmark 2009 NEJM study on the use of nebulized epinephrine and dexamethasone for treating Bronchiolitis, and the future of Bronchiolitis research. Published online: February 2015 

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