phenylephrine-hydrochloride and Bronchiolitis

Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed.

Topics: Acute Disease; Bronchiolitis; Cannula; Humans; Nose; Oxygen Inhalation Therapy

High flow nasal cannula (HFNC) is a relatively new non-invasive ventilation therapy that seems to be well tolerated in children. Recently a marked increase in the use of HFNC has been seen both in paediatric and adult care settings. The aim of this study was to review the current knowledge of HFNC regarding mechanisms of action, safety, clinical effects and tolerance in children beyond the newborn period.We performed a systematic search of the databases PubMed, Medline, EMBASE and Cochrane up to 12th of May 2016. Twenty-six clinical studies including children on HFNC beyond the newborn period with various respiratory diseases hospitalised in an emergency department, paediatric intensive care unit or general ward were included. Five of these studies were interventional studies and 21 were observational studies. Thirteen studies included only children with bronchiolitis, while the other studies included children with various respiratory conditions. Studies including infants hospitalised in a neonatal ward, or adults over 18 years of age, as well as expert reviews, were not systematically evaluated, but discussed if appropriate.The available studies suggest that HFNC is a relatively safe, well-tolerated and feasible method for delivering oxygen to children with few adverse events having been reported. Different mechanisms including washout of nasopharyngeal dead space, increased pulmonary compliance and some degree of distending airway pressure may be responsible for the effect. A positive clinical effect on various respiratory parameters has been observed and studies suggest that HFNC may reduce the work of breathing. Studies including children beyond the newborn period have found that HFNC may reduce the need of continuous positive airway pressure (CPAP) and invasive ventilation, but these studies are observational and have a low level of evidence. There are no international guidelines regarding flow rates and the optimal maximal flow for HFNC is not known, but few studies have used a flow rate higher than 10 L/min for infants.Until more evidence from randomized studies is available, HFNC may be used as a supplementary form of respiratory support in children, but with a critical approach regarding effect and safety, particularly when operated outside of a paediatric intensive care unit.

Topics: Bronchiolitis; Cannula; Child; Continuous Positive Airway Pressure; Equipment Design; Humans; Nose; Oxygen Inhalation Therapy

High flow nasal cannula (HFNC) devices deliver an adjustable mixture of heated and humidified oxygen and air at a variable flow rate. Over recent years HFNC devices have become a frequently used method of non-invasive respiratory support in infants and preterm neonates that is generally popular amongst clinicians and nursing staff due to ease of use and being well tolerated by patients. Despite this rapid adoption relatively little is known about the exact mechanisms of action of HFNC however and only recently have data from randomised controlled trials started to become available. We describe the features of a modern HFNC device and discuss current knowledge about the mechanisms of action and results of clinical studies in preterm neonates and infants with bronchiolitis. We also highlight future areas of research that are likely to increase our understanding, inform best clinical practice and strengthen the evidence base for the use of HFNC.

Topics: Bronchiolitis; Catheterization; Evidence-Based Medicine; Humans; Infant; Infant, Newborn; Noninvasive Ventilation; Nose

This study aimed to compare the traditional bulb aspirator with a nasal-oral aspirator in the treatment of bronchiolitis.. This was a single-center, single-blind, randomized controlled trial. Patients with bronchiolitis discharged from the emergency department were randomized to receive a bulb or nasal-oral aspirator for home use.Data regarding return visits, hydration, respiratory relief, parental satisfaction, device preference, and adverse events were gathered using a predistribution questionnaire, diary, poststudy questionnaire, and chart review.. There was not a statistically significant difference in the rate of unscheduled return visits (bulb vs nasal-oral, 28.2% vs 20.7%; P = 0.26). No difference was seen in hydration or respiratory relief in either the diary or poststudy questionnaire. The nasal-oral aspirator had higher satisfaction rates (bulb vs nasal-oral, 68.8% vs 93.9%; P < 0.01). When asked which device was preferred with regard to all devices ever tried, 57.2% of respondents reported the nasal-oral aspirator. More adverse events were seen with the bulb compared with the nasal-oral aspirator (bulb vs nasal-oral, 50.0% vs 17.5%; P < 0.01).. No difference was appreciated between the bulb and nasal-oral aspirators in unscheduled return rates. The nasal-oral aspirator demonstrated higher parental satisfaction and preference rates, and fewer adverse effects compared with the bulb aspirator. Medical providers should have a cost-benefit discussion with caregivers when recommending home aspirators for the treatment of bronchiolitis.Registry ClinicalTrials.gov Identifier: NCT03288857. Comparison of the Bulb Aspirator With a Nasal-Oral Aspirator in the Treatment of Bronchiolitis.

Topics: Bronchiolitis; Drug-Related Side Effects and Adverse Reactions; Emergency Service, Hospital; Humans; Nose; Single-Blind Method

Topics: Bronchiolitis; Continuous Positive Airway Pressure; Humans; Nose; Positive-Pressure Respiration

Respiratory syncytial virus is the most common cause of lower respiratory tract infections in infants and young children. While the majority of infants display only mild upper respiratory tract infection or occasionally otitis media, around one-third will develop an infection of the lower respiratory tract, usually bronchiolitis. There is now convincing evidence from a number of cohorts that respiratory syncytial virus is a significant, independent risk factor for later wheezing, at least within the first decade of life. The wide variation in response to respiratory syncytial virus infection suggests that susceptibility and disease are influenced by multiple host-intrinsic factors.. A 2-year-old white girl presented to our Pediatric Allergy Clinic with recurrent crackles in addition to cough, fevers, and labored breathing since her first respiratory syncytial virus infection at the age of 7 months. She had been under the care of pulmonologists, who suspected childhood interstitial lung disease. She was hospitalized eight times due to exacerbation of symptoms and prescribed systemic and inhaled steroids, short-acting β2-mimetics, and antileukotriene. There was no short-term clinical improvement at that time between hospitalizations. During her hospital stay at the Pneumonology and Cystic Fibrosis Department in Rabka a bronchoscopy with bronchoalveolar lavage was performed. Laboratory bacteriological tests found high colony count of Moraxella catarrhalis (β-lactamase positive), sensitive to amoxicillin-clavulanate, in bronchial secretions and swabs from her nose. After this, infections were treated with antibiotics; she remained in good condition without symptoms. Crackles and wheezing recurred only during symptoms of infections. Therefore, we hypothesize that respiratory syncytial virus infection at an early age might cause severe damage of the lung epithelium and prolonged clinical symptoms, mainly crackles and wheezing, each time the child has a respiratory infection.. This case illustrates the importance of respiratory syncytial virus infection in an immunocompetent child. Pediatricians need to have a high index of suspicion and knowledge of recurrent symptoms associated with severe damage of the lung epithelium to establish the correct diagnosis.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchiolitis; Bronchoalveolar Lavage Fluid; Child, Preschool; Female; Humans; Moraxella catarrhalis; Moraxellaceae Infections; Nose; Respiratory Sounds; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human; Respiratory Tract Infections

Nasal biomarkers have potential to add objectivity to the clinical assessment of the child with bronchiolitis. We aim to study, if nasal caspase and high-mobility group box 1 protein (HMGB1) levels differ between patients who were hospitalized and those discharged from the emergency department (ED), among patients with bronchiolitis.. Using an observational cross-sectional study design, we recruited patients younger than 24 months presenting to the ED from September 1, 2015 to May 31, 2017 with a diagnosis of acute bronchiolitis. We described the patients' clinical severity measured by the modified respiratory index score (RIS), and performed standardized collection and analysis of nasal caspase and HMGB1 levels.. Among 85 patients recruited, the median age was 5.0 months (interquartile range, IQR 3.3-7.2) and the median modified RIS score was 3 (IQR 2-4). Hospitalized patients had a 2.4-fold higher HMGB1 level than patients who were discharged from the ED (2.558 μg/mL [IQR 1.038-5.125] vs 1.056 μg/mL [IQR 0.409-2.395], P = 0.0013). There was no difference in median caspase level between hospitalized and discharged patients. The Area Under the Receiver Operating Characteristics curve predicting hospitalization was 0.7021 for HMGB1 compared to 0.5709 for RIS in this bronchiolitis cohort.. Our study findings show that nasal HMGB1 levels significantly differentiate between young children with bronchiolitis who were hospitalized compared to those fit for discharge. This exploratory study holds potential for future research on nasal HMGB1 for severity stratification in young children with acute bronchiolitis.

Topics: Biomarkers; Bronchiolitis; Caspases; Cohort Studies; Cross-Sectional Studies; Emergency Service, Hospital; Female; HMGB1 Protein; Hospitalization; Humans; Infant; Male; Nasal Mucosa; Nose; Patient Discharge; Severity of Illness Index

To describe the changes to paediatric intensive care unit (PICU) admission patterns and ventilation requirements for children with bronchiolitis following the introduction of humidified high-flow nasal cannula oxygen outside the PICU.. Retrospective study comparing patients <24 months of age with a discharge diagnosis of bronchiolitis admitted to the PICU. A comparison was made between those before humidified high-flow nasal cannula oxygen use (year 2008) to those immediately following the introduction of humidified high-flow nasal cannula oxygen use (year 2011) and those following further consolidation of humidified high-flow nasal cannula oxygen use outside the PICU (year 2013).. Humidified high-flow nasal cannula oxygen use up to 1 L/kg/min in the hospital did not reduce PICU admission. Intubation rates were reduced from 22.2% in 2008 to 7.8% in 2013. There was a non-significant trend towards decreased length of stay in the PICU while hospital length of stay showed a significant decrease following the introduction of humidified high-flow nasal cannula oxygen. Age <6 months and respiratory syncytial virus bronchiolitis were associated with an increased chance of failing humidified high-flow nasal cannula oxygen therapy.. Humidified high-flow nasal cannula oxygen utilised outside of the PICU in our institution for children with bronchiolitis did not reduce admission rates or length of stay to the PICU but was associated with a decreasing need for invasive ventilation and reduced hospital length of stay.

Topics: Bronchiolitis; Cannula; Female; Humans; Infant; Intensive Care Units, Pediatric; Male; Nose; Oxygen Inhalation Therapy; Retrospective Studies

High-flow nasal cannula (HFNC) therapy provides noninvasive respiratory support for infant bronchiolitis and its use has increased following good clinical experiences. This national study describes HFNC use in Finland during a severe respiratory syncytial virus (RSV) epidemic.. A questionnaire on using HFNC for infant bronchiolitis during the 2015-2016 RSV epidemic was sent to the head physicians of 18 Finnish children's hospitals providing inpatient care for infants: 17 hospitals answered, covering 77.5% of the infants born in Finland in 2015.. Most (85%) HFNC was given on paediatric wards. The mean incidence for bronchiolitis treated with HFNC in infants under the age of one in 15 of 17 hospitals was 3.8 per 1000 per year (range: 1.4-8.1): one hospital did not supply the relevant data and one supplied a figure of 34.1 due to a different treatment policy. Instructions on how to start and wean HFNC therapy were present in 71% and 61% of the hospitals, respectively, weighted to the population. Providing weaning instructions was associated with shorter weaning times.. High-flow nasal cannula was actively used for infants with bronchiolitis, with no substantial overuse. Randomised controlled studies are needed before any evidence-based guidelines can be constructed for using HFNC in infant bronchiolitis.

Topics: Biomedical Research; Bronchiolitis; Cannula; Evidence-Based Medicine; Finland; Health Care Surveys; Humans; Infant; Needs Assessment; Nose; Oxygen Inhalation Therapy; Practice Guidelines as Topic; Respiratory Syncytial Virus Infections

It is not clearly established if coinfections are more severe than single viral respiratory infections.The aim of the study was to study and to compare simple infections and viral coinfections of respiratory syncytial virus (RSV) in hospitalized children.From September 2005 to August 2013, a prospective study was conducted on children younger than 14 years of age, admitted with respiratory infection to the Pediatric Department of the Severo Ochoa Hospital, in Spain. Specimens of nasopharyngeal aspirate were taken for virological study by using polymerase chain reaction, and clinical data were recorded. Simple RSV infections were selected and compared with double infections of RSV with rhinovirus (RV) or with human bocavirus (HBoV).In this study, 2993 episodes corresponding to 2525 children were analyzed. At least 1 virus was detected in 77% (2312) of the episodes. Single infections (599 RSV, 513 RV, and 81 HBoV) were compared with 120 RSV-RV and 60 RSV-HBoV double infections. The RSV-RV coinfections had fever (63% vs 43%; P < 0.001) and hypoxia (70% vs 43%; P < 0.001) more often than RV infections. Hypoxia was similar between single or dual infections (71%). Bronchiolitis was more frequent in the RSV simple group (P < 0.001). Pediatric intensive care unit admission was more common in RSV simple or RSV-RV groups than in the RV monoinfection (P = 0.042).Hospitalization was longer for both RSV simple group and RSV-HBoV coinfection, lasting about 1 day (4.7 vs 3.8 days; P < 0.001) longer than in simple HBoV infections. There were no differences in PICU admission. RSV single group was of a younger age than the other groups.Coinfections between RSV-RV and RSV-HBoV are frequent. Overall viral coinfections do not present greater severity, but have mixed clinical features.

Topics: Adolescent; Bronchiolitis; Child; Coinfection; Female; Human bocavirus; Humans; Male; Nose; Parvoviridae Infections; Picornaviridae Infections; Prospective Studies; Respiratory Syncytial Virus Infections; Rhinovirus

To determine whether the introduction of heated humidified high-flow nasal cannulae (HFNC) therapy was associated with decreased rates of intubation for infants <24 months old with bronchiolitis admitted to a pediatric intensive care unit (PICU).. A retrospective chart review of infants with bronchiolitis admitted before and in the season after introduction of HFNC.. In the season after the introduction of HFNC, only 9% of infants admitted to the PICU with bronchiolitis required intubation, compared with 23% in the prior season (P=.043). This 68% decrease in need for intubation persisted in a logistic regression model controlling for age, weight, and RSV status. HFNC therapy resulted in a greater decrease in respiratory rate compared with other forms of respiratory support, and those infants with the greatest decrease in respiratory rate were least likely to be intubated. In addition, median PICU length of stay for children with bronchiolitis decreased from 6 to 4 days after the introduction of HFNC.. We hypothesize that HFNC decreases rates of intubation in infants with bronchiolitis by decreasing the respiratory rate and work of breathing by providing a comfortable and well-tolerated means of noninvasive ventilatory support.

Topics: Bronchiolitis; Child, Preschool; Female; Follow-Up Studies; Hot Temperature; Humans; Humidity; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Male; Nose; Oxygen Inhalation Therapy; Retrospective Studies; Treatment Outcome

Although the most frequent extra-pulmonary manifestations of respiratory syncytial virus (RSV) infection involve the cardiovascular system, no data regarding heart function in infants with bronchiolitis associated with RSV infection have yet been systematically collected. The aim of this study was to verify the real frequency of heart involvement in patients with bronchiolitis associated with RSV infection, and whether infants with mild or moderate disease also risk heart malfunction.. A total of 69 otherwise healthy infants aged 1-12 months with bronchiolitis hospitalised in standard wards were enrolled. Pernasal flocked swabs were performed to collect specimens for the detection of RSV by real-time polymerase chain reaction, and a blood sample was drawn to assess troponin I concentrations. On the day of admission, all of the infants underwent 24-hour Holter ECG monitoring and a complete heart evaluation with echocardiography. Patients were re-evaluated by investigators blinded to the etiological and cardiac findings four weeks after enrollment.. Regardless of their clinical presentation, sinoatrial blocks were identified in 26/34 RSV-positive patients (76.5%) and 1/35 RSV-negative patients (2.9%) (p < 0.0001). The blocks recurred more than three times over 24 hours in 25/26 RSV-positive patients (96.2%) and none of the RSV-negative infants. Mean and maximum heart rates were significantly higher in the RSV-positive infants (p < 0.05), as was low-frequency power and the low and high-frequency power ratio (p < 0.05). The blocks were significantly more frequent in the children with an RSV load of ≥100,000 copies/mL than in those with a lower viral load (p < 0.0001). Holter ECG after 28 ± 3 days showed the complete regression of the heart abnormalities.. RSV seems associated with sinoatrial blocks and transient rhythm alterations even when the related respiratory problems are mild or moderate. Further studies are needed to clarify the mechanisms of these rhythm problems and whether they remain asymptomatic and transient even in presence of severe respiratory involvement or chronic underlying disease.

Topics: Bronchiolitis; Echocardiography; Female; Heart; Heart Rate; Humans; Infant; Male; Nose; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human; Sinoatrial Block; Troponin

The inspired oxygen concentration (FiO(2)) is an important criterion for assessing the severity of bronchiolitis. Oxygen delivery by nasal prongs is a measure of oxygen flow, but not FiO(2). We aimed to determine whether FiO(2) of oxygen delivered by nasal prongs could be predicted from nasal flow by relating arterial oxygen concentrations achieved with prongs to those achieved via head box in children with bronchiolitis.. This is a pilot study conducted at a tertiary referral paediatric hospital. We studied hospitalised children less than 24 months old requiring supplemental oxygen because of bronchiolitis, an acute viral lower respiratory tract infection. Children admitted to the intensive care unit, and those with congenital cardiac disease or recent bronchodilator use were excluded. Subjects were studied in nasal prong, then head box oxygen. Arterial oxygen concentration was measured by a transcutaneous probe (tcPO(2)). Oxygen flows by nasal prongs and FiO(2) by head box were adjusted to achieve similar tcPO(2) readings. FiO(2) values were plotted against oxygen flow rates based on matching tcPO(2).. We recorded tcPO(2) across a satisfactory range of values in eight children. TcPO(2) increased with increasing FiO(2) and nasal oxygen flow, but at variable rates between subjects. FiO(2) increased with increasing nasal oxygen flow, but this relationship was highly variable.. In this study, it was not possible to estimate FiO(2) reliably from nasal oxygen flow rates in children with bronchiolitis. Nasal prong oxygen flow rates should be used with caution when assessing the severity of bronchiolitis in children.

Topics: Bronchiolitis; Drug Administration Routes; Female; Humans; Infant, Newborn; Male; Monitoring, Physiologic; Nose; Oxygen; Oxygen Consumption; Oxygen Inhalation Therapy; Oxyhemoglobins; Pilot Projects; Victoria

Diffuse panbronchiolitis (DPB) is a pulmonary disease of unknown origin with inflammation in the respiratory bronchioles, bronchiectasis, and recurrent sinusitis. Patients with DPB suffer from chronic airway infections resulting from mucociliary dysfunction. Whereas a high concentration of nasal nitric oxide (NO) has been documented in healthy subjects, only two diseases are known to reduce nasal NO: primary ciliary dyskinesia syndrome and cystic fibrosis. We hypothesized that patients with DPB have abnormal levels of nasal NO. To test our hypothesis, we measured NO with the chemiluminescence technique. Air was sampled directly from the nose in 15 healthy subjects and eight patients with DPB. Nasal NO was 88% lower in DPB patients than in the age-matched control subjects (69 +/- 70 versus 556 +/- 87 nl/min; p < 0.001). Treatment with erythromycin for 2 wk did not alter the nasal NO in four control subjects. DPB is the third pulmonary disease in which nasal NO is low. The reduced nasal NO may well be involved in the pathogenesis of DPB, and NO measurements may serve as a noninvasive test in the diagnosis of DPB.

Topics: Adult; Aged; Analysis of Variance; Breath Tests; Bronchiolitis; Female; Humans; Male; Middle Aged; Nitric Oxide; Nose