Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- tosse
- taquipneia
- sibilância
- retrações, gemência e batimento da asa do nariz
Outros fatores diagnósticos
- rinite
- achados clínicos variáveis
- irritabilidade, mal-estar e baixa aceitação alimentar
- febre <40 °C (<104 °F)
- estertores
- apneia
- assincronia toracoabdominal
Fatores de risco
- crianças <3 anos
- meses do inverno
- prematuridade ou displasia broncopulmonar
- exposição passiva à fumaça de cigarro e à poluição do ar
- desobstrução das vias aéreas e função prejudicadas
- cardiopatia congênita
- imunodeficiência
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- oximetria de pulso
Investigações a serem consideradas
- detecção rápida de antígeno por ensaio de imunoadsorção enzimática (ELISA)
- radiografia torácica
- reação em cadeia da polimerase via transcriptase reversa (RT-PCR)
Novos exames
- testes de função pulmonar em lactentes
Algoritmo de tratamento
bronquiolite confirmada
Colaboradores
Autores
Howard B. Panitch, MD
Professor
Division of Pulmonary Medicine
Children's Hospital of Philadelphia
Philadelphia
PA
Declarações
HBP is a member of the American Thoracic Society's Guideline Committee, Long-Term Oxygen Therapy for Infants and Children, past Chair of the American College of Chest Physicians' Home Based Mechanical Ventilation and Neuromuscular Disease NetWork, a member of the ATS guideline committee on bronchopulmonary dysplasia (BPD), and a member of the current new guideline committee updating the BPD Statement. He is a member of the planning committee of the Pediatric Assembly of the American Thoracic Society, and receives royalties from Up-To-Date for the review of two topics (Spirometry in Children and Bronchopulmonary Dysplasia).
Agradecimentos
Professor Panitch would like to gratefully acknowledge Dr Isaac Desheng Liu, Dr Woon Li Seo, Dr Jennifer L. Nayak, Dr Caroline B. Hall, and Dr Clement L. Ren, previous contributors to this topic.
Declarações
IDL, WLS, JLN, and CLR declare that they have no competing interests. CBH is an author of a number of references cited in this topic.
Revisores
Robert Welliver, MD
Professor of Pediatrics
Women and Children's Hospital
Buffalo
NY
Declarações
RW declares that he has no competing interests.
Giovanni Piedimonte, MD
Wyeth Research Scholar Professor and Chair
Department of Pediatrics
WVU School of Medicine
Physician-in-Chief
WVU Children's Hospital
Morgantown
WV
Declarações
GP declares that he has no competing interests.
H. Cody Meissner, MD
Professor of Pediatrics
Infectious Disease
Department of Pediatrics
Tufts-New England Medical Center
Boston
MA
Declarações
HCM is an author of a number of references cited in this topic.
John Henderson, MBBS
Professor of Paediatric Respiratory Medicine
University of Bristol
Bristol
UK
Declarações
JH declares that he has no competing interests.
Referências
Principais artigos
McCulloh R, Koster M, Ralston S, et al. Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2015 Oct;169(10):898-904.Texto completo Resumo
Cunningham S, Rodriguez A, Adams T, et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet. 2015 Sep 12;386(9998):1041-8.Texto completo Resumo
Lin J, Zhang Y, Xiong L, et al. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child. 2019 Jun;104(6):564-76. Resumo
Farley R, Spurling GK, Eriksson L, et al. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014 Oct 9;(10):CD005189.Texto completo Resumo
Zhang L, Mendoza-Sassi RA, Wainwright CE, et al. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2023 Apr 4;4(4):CD006458.Texto completo Resumo
Liet JM, Ducruet T, Gupta V, et al. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2015 Sep 18;(9):CD006915.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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