Oxygen treatment of acute bronchiolitis
Acute bronchiolitis is the most common lower respiratory tract infection in children under two years of age. Treatment of acute bronchiolitis is supportive, i.e. application of oxygen to children with hypoxaemia and care for proper hydration. The value obtained by pulse oximetry is merely an indirect measurement of the actual oxygen level in the blood and does not reflect the severity of the disease. By the application of oxygen we only correct hypoxaemia, but do not treat the underlying cause. Nevertheless, as there is no clinical sign that would precisely define children with hypoxaemia, pulse oximetry remains the decisive investigation in decision-making about oxygen application. Studies have shown that when assessing the severity of the disease, pediatricians trust the values of oxygen saturation (SpO2) rather than the clinical assessment. Since pulse oximetry has been in use, the percentage of hospitalised patients due to acute bronchiolitis has increased by about 250 %. Guidelines for treating children with acute bronchiolitis are not consistent in terms of specifying a SpO2 cut-off value that requires oxygen therapy. In this review we have critically evaluated these guidelines and presented our own experience regarding oxygen treatment of acute bronchiolitis.
Øymar K, Skjerven HO, Mikalsen IB. Acute bronchiolitis in infants, a review. Scand J Trauma Resusc Emerg Med. 2014 Apr;22(1):23. https://doi.org/10.1186/1757–7241–22–23 PMID:24694087
Mrvič T, Krivec U. Akutni bronhiolitis. Med Razgl. 2016;55 Suppl 4:165–74.
Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016 Jan;374(1):62–72. https://doi.org/10.1056/NEJMra1413456 PMID:26735994
West JB. Difussion: how gas gests across the blood-gas barrier. Respiratory physiology: the essentials. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. pp. 24–35.
West JB. Ventilation-perfusion relationships: how matching of gas and blood determines gas exchange. Respiratory physiology: the essentials. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. pp. 56–76.
West JB. Gas transport by the blood: how gases are moved to and from the peripheral tissues. Respiratory physiology: the essentials. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. pp. 77–94.
Rebuck AS, Chapman KR. The P90 as a clinically relevant landmark on the oxyhemoglobin dissociation curve. Am Rev Respir Dis. 1988 Apr;137(4):962–3. https://doi.org/10.1164/ajrccm/137.4.962 PMID:3355007
Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis. 1992 Jan;145(1):106–9. https://doi.org/10.1164/ajrccm/145.1.106 PMID:1731571
Rojas-Reyes MX, Granados Rugeles C, Charry-Anzola LP. Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev. 2014 Dec;(12):CD005975. https://doi.org/10.1002/14651858.CD005975.pub3 PMID:25493690
Ross PA, Newth CJ, Khemani RG. Accuracy of pulse oximetry in children. Pediatrics. 2014 Jan;133(1):22–9. https://doi.org/10.1542/peds.2013–1760 PMID:24344108
Schuh S, Freedman S, Coates A, Allen U, Parkin PC, Stephens D, et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA. 2014 Aug;312(7):712–8. https://doi.org/10.1001/jama.2014.8637 PMID:25138332
Schroeder AR, Marmor AK, Pantell RH, Newman TB. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Arch Pediatr Adolesc Med. 2004 Jun;158(6):527–30. https://doi.org/10.1001/archpedi.158.6.527 PMID:15184214
Beresford MW, Parry H, Shaw NJ. Twelve-month prospective study of oxygen saturation measurements among term and preterm infants. J Perinatol. 2005 Jan;25(1):30–2. https://doi.org/10.1038/sj.jp.7211206 PMID:15496870
Hunt CE, Corwin MJ, Weese-Mayer DE, Ward SL, Ramanathan R, Lister G, et al.; Collaborative Home Infant Monitoring Evaluation (CHIME) Study Group. Longitudinal assessment of hemoglobin oxygen saturation in preterm and term infants in the first six months of life. J Pediatr. 2011 Sep;159(3):377–383.e1. https://doi.org/10.1016/j.jpeds.2011.02.011 PMID:21481418
Uliel S, Tauman R, Greenfeld M, Sivan Y. Normal polysomnographic respiratory values in children and adolescents. Chest. 2004 Mar;125(3):872–8. https://doi.org/10.1378/chest.125.3.872 PMID:15006944
Bass JL, Corwin M, Gozal D, Moore C, Nishida H, Parker S, et al. The effect of chronic or intermittent hypoxia on cognition in childhood: a review of the evidence. Pediatrics. 2004 Sep;114(3):805–16. https://doi.org/10.1542/peds.2004–0227 PMID:15342857
McCulloh R, Koster M, Ralston S, Johnson M, Hill V, Koehn K, et al. Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis. JAMA Pediatr. 2015 Oct;169(10):898–904. https://doi.org/10.1001/jamapediatrics.2015.1746 PMID:26322819
Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S. Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis. JAMA Pediatr. 2016 Jun;170(6):602–8. https://doi.org/10.1001/jamapediatrics.2016.0114 PMID:26928704
Jackson RM. Pulmonary oxygen toxicity. Chest. 1985 Dec;88(6):900–5. https://doi.org/10.1378/chest.88.6.900 PMID:3905287
Pannu SR. Too Much Oxygen: hyperoxia and oxygen management in mechanically ventilated patients. Semin Respir Crit Care Med. 2016 Feb;37(1):16–22. https://doi.org/10.1055/s-0035–1570359 PMID:26820270
West JB. Control of ventilation. Respiratory physiology: the essentials. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. pp. 125–40.
Martin DS, Grocott MP. Oxygen therapy in critical illness: precise control of arterial oxygenation and permissive hypoxemia. Crit Care Med. 2013 Feb;41(2):423–32. https://doi.org/10.1097/CCM.0b013e31826a44f6 PMID:23263574
Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al.; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474–502. https://doi.org/10.1542/peds.2014–2742 PMID:25349312
National institute for health and care excellence (NICE) guidance. Bronchiolitis in children: diagnosis and management; 2015 [cited 2018 April 10]. Available from: http://www.nice.org.uk/guidance/ng9
Cunningham S, Rodriguez A, Adams T, Boyd KA, Butcher I, Enderby B, et al.; Bronchiolitis of Infancy Discharge Study (BIDS) group. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet. 2015 Sep;386(9998):1041–8. https://doi.org/10.1016/S0140–6736(15)00163–4 PMID:26382998
Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics. 2008 Mar;121(3):470–5. https://doi.org/10.1542/peds.2007–1135 PMID:18310194
Cunningham S, McMurray A. Observational study of two oxygen saturation targets for discharge in bronchiolitis. Arch Dis Child. 2012 Apr;97(4):361–3. https://doi.org/10.1136/adc.2010.205211 PMID:21388970
Krivec U. Zdravljenje akutnega bronhiolitisa z visokim pretokom. In: Kržišnik C, Battelino T, ur. Izbrana poglavja iz pediatrije. Ljubljana; Medicinska fakulteta, Katedra za pediatrijo; 2013- p. 235–239.
Manley BJ, Owen LS, Doyle LW, Andersen CC, Cartwright DW, Pritchard MA, et al. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med. 2013 Oct;369(15):1425–33. https://doi.org/10.1056/NEJMoa1300071 PMID:24106935
Green CA, Yeates D, Goldacre A, Sande C, Parslow RC, McShane P, et al. Admission to hospital for bronchiolitis in England: trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma. Arch Dis Child. 2016 Feb;101(2):140–6. https://doi.org/10.1136/archdischild-2015–308723 PMID:26342094
Long E, Babl FE, Duke T. Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments? Emerg Med J. 2016 Jun;33(6):386–9. https://doi.org/10.1136/emermed-2015–204914 PMID:26727972
Schibler A, Pham TM, Dunster KR, Foster K, Barlow A, Gibbons K, et al. Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive Care Med. 2011 May;37(5):847–52. https://doi.org/10.1007/s00134–011–2177–5 PMID:21369809
Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med. 2018 Mar;378(12):1121–31. https://doi.org/10.1056/NEJMoa1714855 PMID:29562151
Protokol zdravljenja s kisikom pri otroku in mladostniku (2015) PT PEK PULMO 015.
Krivec U, Praprotnik M, Aldeco M. High flow nasal cannula therapy improves clinical and gas exchange parameters in children with acute bronchiolitis. In: European Respiratory Journal – ERS Annual Congress; 2013 Sep 7–11; Barcelona, Španija. p. 408.
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