Management of Moderate to Severe Bronchioltis: A Quality Improvement Project

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Hartman, Chelsea
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2019-05-18
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Bronchiolitis is the leading cause of hospitalization for infants during their first year of life, accounting for 18% of all hospitalizations between the winter months of December to April. Respiratory syncytial virus is the most common viral infection leading to lower respiratory tract infection, but other viruses or multiple viruses may occur as well. In infants who present with bronchiolitis, there is often two-three days of upper respiratory symptoms, a cough, and some mild nasal congestion, before the infant presents with increased work of breathing, retractions, accessory muscle use, and difficulty breathing with symptoms peaking at three to five days of illness. The American Academy of Pediatrics recommend intravenous fluid replacement, nasal suctioning, and supplemental oxygen as necessary, but facilities differ on high-flow nasal cannula, noninvasive ventilation, or endotracheal intubation and escalation in care protocols remain inconsistent. A retrospective chart review performed at Children’s Hospital Colorado from December 2017-April 2018 demonstrated that escalation of oxygen was inconsistent with no clear preference of high-flow nasal cannula over noninvasive ventilation, however when initiating high-flow nasal cannula per the current policy, there was a drastic improvement in patient outcomes including decreased endotracheal intubation rates and total length of stay in days.
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University
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