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 |