Wednesday, March 9, 2011

Acute Bronchiolitis Treatment

Acute Bronchiolitis
Most children diagnosed with acute bronchiolitis can be treated at home. Hospitalization is indicated when the patient is younger than 6 months, shows moderate or severe respiratory failure (50-60 breaths per minute during sleep), severe hypoxemia (oxygen pressure less than 60 mmHg), apnea occurs, intolerance oral nutrition, lack of proper care at home.
Treatment of choice is symptomatic and consists of oxygen, air humidifiers, fluidifiante administration of bronchial secretions, ensuring a good hydration (oral or parenteral), antipyretics to control fever.
Oxygen is administered to combat hypoxia, with the patient placed in a cold environment (18-20 degrees Celsius). If infants are given oxygen in an incubator, and for older children on nasal tube, oxygen mask or oxygen tent used to be sterile to avoid the occurrence of bacterial infections and humidified to prevent drying of secretions from the airways. In the first phase oxygen improves dyspnea, then remove, then disappears, cyanosis, anxiety and agitation baby. Preference should be avoided if possible due to the effect of administration of sedative potential respiratory depressants centers. Favorable position for the infant is sitting on an incline of 30-40 degrees or sitting with head and chest slightly elevated extension.
Correction of dehydration is supplemented by oral fluid intake needs. It requires parenteral rehydration endo-venous infusion (ENP) when oral feeding prevent anorexia and coughing. To rebalance fluid and electrolyte balance in the ENP is administered a dose of liquid between 60-80 ml / kg / day should be avoided vascular overload in a child with imminent cardiac decompensation. Acid-base imbalance will be corrected by administering sodium bicarbonate solution molar concentration of 8, 4% at a dose of 2-3 mEq / kg.
The efficacy of corticosteroids and beta2-agonist bronchodilators, or theophylline in the aerosol is discussed. Antibiotic therapy is indicated if suspicion superinfection or complications (such as otitis).
Administration of ribavirin (antiviral agent) in aerosols in respiratory syncytial virus infection (RSV) was found to have moderate efficacy, because it is a self-limiting viral disease. VIRAZID site is a product designed specifically for the treatment of RSV bronsuiolitei. It is administered in aerosols 12 to 18 hours / day for 3-7 days, the recommended dose is 20 mg / ml for Ribavirin aerosol solution. The vial contains 6 g/100ml.
Antibiotic is given a routine infant hospitalized, but in order to avoid complications. The antibiotic does not reduce the disease but prevents secondary superinfection. We recommend the use of antibiotics in these forms of bronchiolitis: suspected serious forms of bacterial complication, febrile infants younger than 3 months, immunocompromised hosts (malnutrition or other immunodeficiency states, hereditary or acquired), which are signs of bronchopneumonia net. It usually uses a combination of beta-lactams (Ampicillin 150-200 mg / kg) and an aminoglycoside (gentamicin 5-6 mg / kg).
To reduce venous congestion and mucosal edema through vasoconstriction Epinephrine and other adrenergic agonists are used. Glucocorticoids, administered intra-venous (hemisuccinat hydrocortisone) are recommended for their effect antiedematos. The recommended dose is 10-15 mg / kg / day divided in 3-4 hours prize/24.

No comments:

Post a Comment