Management and Prevention Strategies for Respiratory Syncytial Virus (RSV) Bronchiolitis in Infants and Young Children: A Review of Evidence-Based Practice Interventions

Allison C. Cooper; Nancy Cantey Banasiak; Patricia Jackson Allen

Disclosures

Pediatr Nurs. 2003;29(6) 

In This Article

Management

Controversy surrounds the treatment of RSV bronchiolitis. Management of RSV bronchiolitis in infants and young children is predominantly by supportive care measures (AHRQ, 2003; Greenough, 2001). Treatment of bronchiolitis includes maintenance of adequate fluid, sufficient caloric intake to meet the increased basal metabolic needs associated with a respiratory illness, rest, the use of nasal saline drops and suction to promote ease of breathing, and the use of antipyretics/mild analgesics to control fever and minimize irritability associated with discomfort. Most infants and young children with bronchiolitis can be treated at home. Assessment of respiratory status and infant fatigue is critical. Pulse oximeter readings should be taken on all infants and children with symptoms of increased respiratory effort. Close follow up is important and careful instructions should be given to the parents and documented in the record regarding (a) signs of increasing respiratory distress, (b) signs of dehydration, (c) guidelines for oral intake, (d) fever management and antipyretic use, and (e) how to access health care services if symptoms worsen (Goodman & Brady, 2000).

Hospitalization is required for infants and children with tachypnea >70, marked retractions, lethargy, or a history of poor fluid intake. The degree of medical intervention is usually determined by the child's level of oxygenation as indicated by pulse oximetry and/or arterial blood gases (Rodriguez, 1999; Wong et al., 2003). Humidified mist therapy is usually combined with oxygen by hood, tent, isolette, or nasal prongs in concentrations sufficient to alleviate dyspnea and hypoxia. Clinicians must carefully monitor signs of impending respiratory failure, such as the inability to maintain adequate oxygen saturations or rising arterial carbon dioxide levels. Ventilatory assistance (i.e., intubation) should be considered for infants with recurrent apnea or severe oxygen desaturation (Gadomski, 2002). Adequate hydration is also important, however, oral fluid intake may be contraindicated because of tachypnea, weakness, and/or fatigue. Parenteral fluids are usually provided in the hospitalized infant until the acute stage of the disease has passed (Rodriguez, 1999; Wong et al., 2003).

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