We made no changes to our Bronchiolitis Clinical Practice Guideline (CPG),
based on the AAP recommendations, for the following reasons:
1) Grouping all bronchiolitics together, all the way up to age of two
years, eliminates potentially helpful beta agonist therapy to first time
asthmatics, especially those over 6 months of age. Our CPG recommends the
following: 1) Suctioning, then 2) albuterol nebulization x 1, then 3)
possibly albuterol or racemic epi x 1. Based on the presence or absence of
clinical response, these may or may not be continued. So, for the vast
majority of patients, these will not be continued past the initial trial
2) We fail to recognize that "tachycardia", following a very short trial of
albuterol therapy, as a true harmful reaction to albuterol therapy as
stated in the AAP Guideline. Where is the scientific proof that raising the
heart rate slightly in a child less than 2 years of age causes harm?
3) The recent meta-analyses regarding the use of hypertonic saline
following initial beta agonist therapy suggest a potential benefit in
preventing admissions and/or decreasing hospital stays.
So, if any changes our made to our CPG it will be the addition of
hypertonic saline to the CPG rather than complete elimination of all of
these therapies, as recommended by the AAP Guideline.
Division Director, PEM
SSM Health Cardinal Glennon Children's Hospital
Saint Louis University
On Fri, Dec 18, 2015 at 11:51 AM, John M. Howard, DO <
[log in to unmask]> wrote:
> Hello all:
> I’m looking for some feedback on people’s experience on implementing the
> AAP Stewardship in Bronchiolitis (SIB) initiatives in the Peds ED’s if your
> hospital is participating.
> —What is working?
> —What kind of barriers are you encountering?
> —How is your department receiving these initiatives?
> —…and so on...
> If possible, please respond to my preferred e-mail directly:
> [log in to unmask] <mailto:[log in to unmask]>
> Thanks for your time,
> John Howard, DO
> Advocate Lutheran General Hospital
> Park Ridge, IL
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