Bronchiolitis
Content:
Introduction:
Bronchiolitis is a common serious Acute lower Respiratory
tract infection primarily affecting small airways called
bronchioles in infants of age b/w 1 and 6months, can also
affect children upto 2 years of age.
It is the major cause of respiratory distress in children
< 2years of age.
Etiology:
- Disease commonly occurs in winter and spring
- RSV – Most cases(75%)
- Parainfluenza virus
- Rhino virus
- Adeno virus
- Influenza virus
- Mycoplasma
- pneumoniae(occurs rarely)
Pathogenesis:
Viral invasion
Inflamation of bronchiolar mucosa
Hypersecretion, thickening of mucus plug and cellular debris
Bronchiolar spasm
Increased airway resistance
Trapping of air inside alveoli
Emphysema(initial stage)
Complete obstruction
Atelectasis
Reduced ventilation that leads to
ventilation-perfusion mismatch
Hypoxemia , Respiratory acidosis
Clinical features:
- Tachypnea
- Tachycardia
- Raised body temperature
- Nasal flaring
- Chest retractions
- Wheezing
- Fine rales (47%)
- Crepitus on inspiration
- Increased resonance
- Otitis media
- High grade fever Bradypnea or apnea Cyanosis or pale Difficult in feed (<50% than normal)
Investigation:
- RSV testing
- X-ray
- CBC
- ECG
- Serology
- Bronchoscopy (Rarely)
Risk factors:
- Preterm or LBW
- immunodeficiency
- Congenital heart disease
- Anatomical defects of airway
- Bronchopulmonary Dysplasia
Management:
Treat the child primarily on airway, breathing and circulation algorithm
Infants with mild bronchiolitis can be treated in home in humidified
atmosphere.
If respiratory distress increases or feeding problems appear child
should be hospitalized.
In hospital,
A – open , clear and maintain airway, make preferably in sitting
position @ 30 to 40 degree angle.
B – Administer moist oxygen continuously in absence of cyanosis. In
very sick infants may need a concentration 0f 60% oxygen through hood or
high flow nasal prongs.
C – Maintain fluid and electrolyte balance.
- Ribavirin is delivered by nebulized for 3 – 5 days
- > Beta-adrenergic drugs and ipratropium are not recommended for infants less than 6 months.
- > Use of bronchodilators in bronchiolitis suggest beneficial effect of inhaled salbutamol with ipratropium and epinephrine.
- > If pt show improved response to bronchodilators may continue with the same.
- > Continuous positive airway pressure(CPAP) or assisted ventilation may be required to control respiratory failure.
- > ECMO is effective, if respiratory failure is not controlled by mechanical ventilation.
Complications:
- Cyanosis
- Dehydration
- Fatigue
- Acute respiratory distress syndrome (ARDS)
- Bronchiolitis obliterans
- Congestive heart failure
- Myocarditis
- Arrhythmias
- Chronic lung disease
This website for medical students who struggle to study over the books this for yours we are given as a consiced format more...
No comments:
Post a Comment