Additionally, pulse oximetry is associated with frequent false alarms and parental stress and fatigue. Clinicians may choose not to given additional oxygen to children with bronchiolitis if their oxygen saturation is above 90%. Additionally, clinicians may choose not to use continuous pulse oximetry in these people.When choosing to use oxygen therapy for a child with bronchiolitis, there is evidence that home oxygen may reduce hospitalization rate and length of stay although readmission rates and follow-up visits are increased. Also, the use of humidified, heated, high-flow nasal cannula may be a safe initial therapy to decrease work of breathing and need for intubation. However, evidence is lacking regarding the use of high-flow nasal cannula compared to standard oxygen therapy or continuous positive airway pressure. These practices may still be used in severe cases prior to intubation.Blood gas testing is not recommended for people hospitalized with the disease and is not useful in the routine management of bronchiolitis. People with severe worsening respiratory distress or impending respiratory failure may be considered for capillary blood gas testing. Hypertonic saline
Guidelines recommend against the use of nebulized hypertonic saline in the emergency department for children with bronchiolitis but it may be given to children who are hospitalized.Nebulized hypertonic saline (3%) has limited evidence of benefit and previous studies lack consistency and standardization. A 2017 review found tentative evidence that it reduces the risk of hospitalization, duration of hospital stay, and improved the severity of symptoms.
Azithromycin adjuvant therapy may reduce the duration of wheezing and coughing in children with bronchiolitis but has not effect on length of hospital stay or duration of oxygen therapy. Corticosteroids, although useful in other respiratory disease such as asthma and croup, have no proven benefit in bronchiolitis treatment and are not advised. Additionally, corticosteroid therapy in children with bronchiolitis may prolong viral shedding and transmissibility. The overall safety of corticosteroids is questionable. Leukotriene inhibitors, such as montelukast, have not been found to be beneficial and may increase adverse effects. Immunoglobulins are of unclear benefit. Epidemiology
Bronchiolitis typically affects infants and children younger than two years, principally during the autumn and winter. It is the leading cause of hospital admission for respiratory disease among infants in the United States and accounts for one out of every 13 primary care visits. Bronchiolitis accounts for 3% of emergency department visits for children under 2 years old. Bronchiolitis is the most frequent lower respiratory tract infection and hospitalization in infants worldwide. References
External links
Bronchiolitis. Patient information from NHS Choices
"Bronchiolitis in children – A national clinical guideline" (PDF). Archived from the original (PDF) on 4 March 2016. Retrieved 6 December 2007. (1.74 MB)   from the Scottish Intercollegiate Guidelines Network
Ralston, SL; Lieberthal, AS; Meissner, HC; Alverson, BK; Baley, JE; Gadomski, AM; Johnson, DW; Light, MJ; Maraqa, NF; Mendonca, EA; Phelan, KJ; Zorc, JJ; Stanko-Lopp, D; Brown, MA; Nathanson, I; Rosenblum, E; Sayles S, 3rd; Hernandez-Cancio, S (27 October 2014). "Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis". Pediatrics.