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

RecommendationIntervention or TestQuote Related to Severe IllnessPage
1cChest radiograph“Initial radiography should be reserved for cases…severe enough to warrant ICU admission…”e1479
2Albuterol“Children with severe disease or…respiratory failure were generally excluded…and this evidence cannot be generalized to these situations”e1481
3Racemic epinephrine“This evidence suggests epinephrine should not be used in children hospitalized for bronchiolitis, except potentially as a rescue agent in severe disease…”e1481
4bHypertonic saline“It has not been studied in intensive care settings, and most trials have included only patients with mild to moderate disease”e1483
8Antibiotics“…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