I agree with Marty and here is my rationale:
1 The Guideline was based on a "Retrospectve, observational cohort
population, over 130,000 HOSPITALIZED patients"
2 No clear guidance on how to diagnose PURE Bronchiolitis and be able to
separate out those with atopy or underlying asthma.
see: Lehtinen, P., Ruohola, A., Vanto, T. et al. Prednisolone
reduces recurrent wheezing after a first wheezing episode associated with
rhinovirus infection or eczema. J Allergy Clin Immunol. 2007; 119: 570–575
3 The practice of Evidence Based medicine is the *confluence* of 3 realms
a. Clinical Expertise : our own experience
b. The Evidence : The literature (of which practice guidelines are
hardly at the pinnacle)
c. The patient's (or parent's) perspective
Without expertise, evidence can tyrannize practice (read COOKBOOK
Without evidence, expertise can become outdated (read DOGMA)
My own experience is that Albuterol benefits 1/3 to 1/2 of patients under 2
years with first time wheezing in this season.
"Tis the Season to be Wheezin' ".
Just my 2 cents.
On Thu, Oct 30, 2014 at 8:30 PM, Marty Herman <[log in to unmask]> wrote:
> I do not plan to use the AAP guidelines. It has been my experience that
> some kids do benefit from albuterol with bronchiolitis,I also have seen
> nice improvement with racemic epi, and epi nebs, Recently I have added
> hypertonic saline to my armamentarium and think it helps..
> Martin Herman, M.D.
> Pediatric Emergency Medicine
> Sacred Heart Children's Hospital
> Email: [log in to unmask]
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> > Date: Thu, 30 Oct 2014 15:17:57 -0700
> > From: [log in to unmask]
> > Subject: My name is Dr. Indigo Montoya, You Killed Albuterol..
> > To: [log in to unmask]
> > ... prepare to die.
> > In face of the recent AAP Guideline on the management of bronchiolitis, I
> > am recruiting other Peds ED centers who will be endorsing this set of
> > practices to serve as the treatment group in my non-randomized
> > observational study. Our center will serve as the 'out-of-control' group
> > and we will be initiating a new clinical pathway entitled... 'Empiric
> > therapy for the treatment of undifferentiated respiratory distress in
> > infants.'
> > It is my hypothesis that our group's admission and bounce-back rates will
> > be the same as last year.
> > I anxiously await the data from the centers who adopt the AAP approach!
> > Jay Fisher MD
> > Medical Director, Peds EM, Children's Hospital of NV
> > Physician Consultant, Dread Pirate Roberts
> > For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> > http://listserv.brown.edu/ped-em-l.html
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
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