Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2015; 4(3): 152-158
Published online Aug 4, 2015. doi: 10.5492/wjccm.v4.i3.152
From bronchiolitis guideline to practice: A critical care perspective
James A Lin, Andranik Madikians
James A Lin, Andranik Madikians, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mattel Children’s Hospital UCLA, University of California, Los Angeles, CA 90095, United States
Author contributions: Both authors contributed to this manuscript.
Conflict-of-interest statement: The authors have disclosed that they have no potential conflicts of interest (including but not limited to commercial, personal, political, intellectual, or religious interests) that are related to the work submitted for consideration of publication. This is an unfunded work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: James A Lin, MD, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mattel Children’s Hospital UCLA, 10833 Le Conte Ave, Mail Code 175217, Los Angeles, CA 90095, United States. jameslin@mednet.ucla.edu
Telephone: +1-310-8259124 Fax: +1-310-7946623
Received: March 5, 2015
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
Abstract

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.

Keywords: Respiratory syncytial virus; Rhinovirus; Asthma; Hypertonic nebulized saline; Acute viral bronchiolitis

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.