#2 Bronchiolitis: 2019 RSV Update

Guest: Miguel Knochel, MD, FAAP

February 2019



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Show Notes


Neither the speaker, planners, nor anyone in control of content for this Podcast has any relevant financial relationship(s).


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Learning Objectives

After listening to these episodes listeners will…

  • learn what the recent literature on bronchiolitis shows about hypertonic saline, pulse oximetry, invasive suctioning high-flow nasal cannula.
  • discuss treatments and testing options to avoid doing routinely: CXR, viral testing systemic steriods, inhaled bronchodilators, invasive suctioning (NEW), continuous oximety (NEW).
  • discuss when to use High Flow Nasal Cannula, what flow rates to provide and when it is not helpful.

Time Stamps Episode 2-1

00:00 Introduction
02:46 Disclosures and Guest Introduction
05:23 RSV
07:22 Suctioning
11:00 How to prevent RSV
13:02 Inpatient management, hypertonic saline, pulse oximetry
17:49 Role of oxygen at home, discontinuation
20:47 Suctioning practices in the hospital
22:36 High Flow Nasal Cannula
23:58 Discharge
24:57 Escalation of care
28:50 Outro

Time Stamps Episode 2-2

00:00 Introduction
03:19 Chest X-ray, AAP recommendation
05:53 Viral testing
08:43 Steroids, bronchodialtor
13:09 Choosing Wisely: A Journey
15:10 AAP Change Package: Stewardship in Improving Bronchiolitis
15:45 Office based QI, PDSA cycles
18:34 Outro

Time Stamps Episode 2-3

00:00 Introduction
01:04 High Flow Nasal Cannula
09:27 RSV Vaccine
13:40 Palivizumab
16:33 Outro

Notes Episode 2-4

Dr. Knochel mistakenly mentioned Pediatric Grand Rounds would be March 8th.  The correct date is Thursday, March 7th at 8 am.  Link below.

Regarding flu swabbing guidelines:

Each lab may differ on acceptable specimens, even given these CDC guidelines.   Deep nasal (midturbinate) swab is apparently find for flu testing, but we’re not sure about other viruses.

For respiratory viral testing, Primary Children’s laboratory does not accept nasal swab + throat swab combo or deep nasal swab (yet), but we do take (with proper labeling & order) the following:

BAL, trach aspirate, Nasopharyngeal wash (in sterile saline), nasopharyngeal swab (UTM or M4 medium), nasopharyngeal aspirate (UTM or M4 medium), sputum sample (older kids who can hack up sputum or expectorate an induced sputum specimen).

Of course, a good question to ask before obtaining respiratory panel testing is:  “will this change my management?”  Usually for bronchiolitis the answer is no, unless you suspect influenza and will treat if positive, or if you think it’s pertussis.

Miguel Knochel MD


Written and Hosted by: Paul Wirkus, MD, FAAP
Administrator/Producer/Photographer: Alisa Stoddard, UTAAP Executive Director
Audio Engineer: Phil Wirkus
Music by: Phil Wirkus
Guest: Miguel Knochel, MD, FAAP
Special Thanks to Michelle Hofmann, MD, MPH, FAAP, Rob Willer, DO, FAAP and Eric Coon, MD, FAAP