Promoting High-Value Care During Hospitalist and Intensivist Comanagement in the Care of the Deteriorating Child With Bronchiolitis

Justin Lockwood; Justin Robison; Todd Carpenter; Jennifer Reese

doi:10.1542/hpeds.2017-0225

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TABLE 1

Excerpts Addressing Illness Severity Within Recommendations from the American Academy of Pediatrics’ Clinical Practice Guideline for Routine Bronchiolitis

Recommendation	Intervention or Test	Quote Related to Severe Illness	Page
1c	Chest radiograph	“Initial radiography should be reserved for cases…severe enough to warrant ICU admission…”	e1479
2	Albuterol	“Children with severe disease or…respiratory failure were generally excluded…and this evidence cannot be generalized to these situations”	e1481
3	Racemic epinephrine	“This evidence suggests epinephrine should not be used in children hospitalized for bronchiolitis, except potentially as a rescue agent in severe disease…”	e1481
4b	Hypertonic saline	“It has not been studied in intensive care settings, and most trials have included only patients with mild to moderate disease”	e1483
8	Antibiotics	“…it may be difficult to distinguish between atelectasis and bacterial infiltrate or consolidation…Antibiotic therapy may be justified in some children with bronchiolitis who require intubation and mechanical ventilation for respiratory failure”	e1486