Published online Aug 4, 2015. doi: 10.5492/wjccm.v4.i3.152
Peer-review started: March 5, 2015
First decision: April 27, 2015
Revised: June 12, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: August 4, 2015
Processing time: 165 Days and 16.8 Hours
Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.
Core tip: Pediatric acute viral bronchiolitis is characterized by small airways obstruction due to inflammatory infiltrates and debris. While this pathology has little or no overlap with asthma, the clinical presentation of wheezing may be similar. Emerging methods to distinguish asthmatics from the general bronchiolitis population, stratify patients according to illness severity, and provide more effective pulmonary clearance and respiratory support may improve outcomes for these patients in the pediatric intensive care unit.