5.2. RESPIRATORY DISORDERS IN CHILDREN (BRONCHIOLITE)

(Adapted from evidence-based guideline developed using the National Evidence-Based Guideline Development Process Model).

Related Names

None.

Purpose of assistance

1. Solve the problem of respiratory disorders.
2. Promptly identify respiratory distress, insufficiency and/or arrest, and interventions in relation to patients requiring escalation of therapy.
3. Appropriate therapy due to the diagnosis of other causes
4. respiratory disorders in children.

Patient description

Inclusion criteria

Children younger than 2 years of age usually with severe wheezing or undiagnosed disease, which is characterized by rhinorrhea, cough, fever, shortness of breath and/or respiratory distress.

Exclusion criteria

1. Anaphylaxis.
2. Croup.
3. Epiglottitis.
4. Asphyxia due to the presence of foreign bodies in the respiratory tract.
5. Immersion/drowning.
6. Asthma.

Patient Management

Condition assessment

1. History:

a) onset of symptoms;
b) simultaneous symptoms (fever, cough, rhinorrhea, swelling of the lips/tongue, rash, difficulty breathing, aspiration of foreign objects);
c) contact with other patients;
d) history of wheezing;
d) prior treatment;
e) the number of visits to the emergency department during the last year;
f) number of days of inpatient treatment during the last year;
e) number of times spent in the intensive care unit throughout life;
g) history of premature birth;
c) family history of asthma, eczema or allergy.

2. Examination:

a) a full range of vital signs (temperature, pulse, ND, AT, saturation);
b) laryngeal lumen (normal or narrowed);
c) respiratory noises (whistling, cracking, wheezing, muffled, clean);
d) signs of respiratory failure (grunting, swelling of the wings of the nose, retraction, stridor);
e) weak crying or inability to speak in full sentences (a sign of shortness of breath);
e) skin color (pale, cyanotic, normal)
f) state of consciousness (conscious, flabby, drowsy, unconscious, irritable);
there are) signs of dehydration (+/- sunken eyes, capillary filling delay, mucous membranes moist, but sticky, thyme flat or fallen).

Treatment and intervention

1. Pulse oximetry and capnography should always be used as respiratory monitoring aids.

2. ECG only in the absence of improvement after treatment of respiratory disorders.

3. Respiratory tract:

a) perform oxygen therapy – start with the use of the nasal cannula and, if necessary, go to the usual mask and non-revertive mask to maintain the normal level of oxygenation;
b) sanitize the nasal and/or oral cavity (using an aspiration catheter) with excessive secretion.

4. Aerosol medications – nebulizer epinephrine (3 mg per 3 ml of physiological saline) should be administered to children with severe breathing disorders with bronchiolitis at the prehospital stage, if other procedures (sanitation, oxygen therapy) did not give improvements.

5. Provision of IV access and infusion therapy – the use of infusion therapy for children with respiratory disorders should occur only with dehydration or the need for the introduction of drugs.

6. Steroid drugs are usually ineffective, so they are not used at the pre-hospital stage.

7. Improvement of oxygenation and/or respiratory disorders by non-invasive methods:

a) for severe respiratory disorders, it is necessary to apply constant positive airway pressure (PTPD) or high flow nasal cannula (NKVD) (if any);
b) ventilation through the AMBU bag should be used only in case of respiratory arrest in a child.

8. Epiglottis and intubation:

a) epiglottic devices and intubation should be used if ventilation with an AMBU bag has not yielded results;
b) respiratory tract control should be provided by the least invasive methods.

Patient safety

Routine use of signal beacons and sirens is not recommended during transportation.

Useful information for training

1. Sanitation can be a very effective manipulation to alleviate disorders, as babies breathe through their noses.
2. Oxygen-helium mixture should not be routinely used for respiratory disorders in children.
3. Insufficient evidence base does not allow to recommend the use of inhalation of warm steam or nebulizer physiological saline.
4. Despite previous recommendations for the use of salbutamol, recent studies do not currently indicate its use in bronchiolitis.
5. Ipratropium bromide and other anticholinergics should not be used in pre-hospital bronchiolitis.
6. Although it has been shown that hypertensive saline in aerosol form helps to reduce hospital stay in bronchiolitis, it does not provide instant relief in disorders and, therefore, should not be used at the pre-hospital stage.

Relevant evaluation results

Frequent reassessment is necessary to determine whether interventions alleviate signs of respiratory distress or not.

Key elements of documentation

Document the main details of the survey to assess changes after the interventions:

1. PD.
2. Oxygen saturation.
3. Participation of auxiliary muscles in the act of breathing.
4. Respiratory noises.
5. Laryngeal lumen.
6. State of consciousness.
7. Skin color.

Criteria for the effectiveness of care
 Application of artificial ventilation device PPTD.

Time to administration of protocol-defined interventions.

Rate of administration of therapy (whether or not certain drugs were administered/interventions performed).

Change in vital signs (temperature, pulse, ND, AT, saturation, capnography).

Number of intubation attempts.

Mortality.

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