Showing posts with label bronchiolitis. Show all posts
Showing posts with label bronchiolitis. Show all posts

Tuesday, September 29, 2015

Bronchiolitis and Hypertonic Saline: Review of Randomized Controlled Trials to Determine Effectiveness


By: Lewis First, MD, MS; Editor-in-Chief        
 
    Over the past several years, there have been a number of articles arguing for and against nebulized hypertonic saline (HS) for symptomatic treatment of bronchiolitis with some studies demonstrating efficacy and others not.  So if you combine the results of all of these studies together into one overall review of the data, what can you learn?  That was the goal of Zhang et al. (REF) who looked at the efficacy and safety of nebulized hypertonic saline in bronchiolitic infants via a systematic review of randomized or quasi-randomized controlled trials.   
     24 trials met review criteria involving more than 3200 patients with more than 1700 getting HS.  The results reflect only a moderate quality of overall evidence for reasons the authors discuss, but the bottom line may suggest that HS is a “salternative” to consider in treating your infants with this respiratory infection. 
      So do you use nebulized hypertonic saline on your hospitalized patients with bronchiolitis?  Do you find it works?  Share your thoughts with us by responding to this blog, sending us an e-letter or posting a comment on our Facebook or Twitter sites.

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Wednesday, April 23, 2014

Admit It—You Want to Try Home Oxygen for Bronchiolitis via the ED But Aren’t Sure If Benefits Outweigh Risks—Read On!

Photo by Zappy's Technology via Flickr
While hypoxia in the emergency setting usually means an inpatient admission, when there is mild hypoxia and good follow-up, perhaps sending a patients home from the emergency department on home oxygen might be an acceptable option. Yet what happens to those children sent home on extra
oxygen support?

Flett et al. (doi: 10.1542/peds. 2013-1872) studied a retrospective cohort of more than 230 consecutive patients sent home on oxygen rather than initially admitted. How these patients fared, including their need for readmission or other complications, is well-categorized in this interesting article that may change the way you manage your bronchiolitic patients.

Take a deep breath and read this study to learn more. While you’re at it, turn to a commentary by pediatric emergency medicine specialist Dr. Stephen Teach (doi: 10.1542/peds. 2014-0512) who offers his input on this study.

Are your patients with bronchiolitis being followed on home oxygen? Share your thoughts on what you do or about this study via a response to our blog, an eLetter, or our Facebook or Twitter sites.

Related Reading:

Thursday, February 20, 2014

Quality Improvement: Reducing Utilization for Inpatients with Bronchiolitis

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our March issue:

We all know that the mainstay of treatment for bronchiolitis is time. Still, some children require hospitalization for respiratory support. Once in the hospital, it is all too easy to order tests and unnecessary treatment. Is it possible to change that?
Photo by Lumax Art via Flickr

Dr. Mittal and colleagues (doi: 10.1542/peds.2013-2881) share their experience in decreasing utilization without worsening care. Though implementing clinical practice guidelines can be a complex process, Dr. Mittal’s team successfully developed and implemented guidelines for management of bronchiolitis in children less than 2 years old. Their implementation not only involved teamwork and collaboration (including monthly team meetings), but provider education, online access to the clinical practice guidelines, order sets and data sharing. Read more of the quality report to learn what impact this had on resource utilization and length of stay.

Spend some time that you would otherwise use ordering tests to let us know how you can decrease unnecessary utilization. Leave a comment below, submit an eLetter on our journal site, or join the conversation on Facebook or Twitter.

Thursday, September 19, 2013

Thinking of Trying Oral Dexamethasone for Bronchiolitis? Have We Got a Study For You!

Bronchiolitis studies are frequent nowadays as multiple investigators search for the elusive treatment that will result in improved outcomes. A number of studies have looked at the risks and benefits of intravenous and inhaled steroids in treating this disorder, but not necessarily the role of oral dexamethasone—at least until Al-Ansari et al. (doi: 10.1542/peds.2012-3746) performed a randomized controlled study looking at the efficacy and safety of dexamethasone versus placebo in 200 hospitalized patients with asthma-risk based on family history of asthma or having eczema as an infant. All patients also received inhaled salbutamol.  Length of stay was the primary outcome indicator, but the risk of side effects was also evaluated. The results are good ones to read about and perhaps implement in your own young patients with bronchiolitis and asthma-risk. See for yourself what I mean by following the link to this article to learn more.