Date of Award

2024

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Metzger, Jay

Keywords

Viral Bronchitis; Pediatric; Management; Respiratory Syncytial Virus; RSV; HFNC; CPAP

Abstract

Viral bronchitis is a disease process most common in children under two years old. Bronchiolitis is caused by inflammation of the epithelial cell lining of the small airways in the lungs. This causes increased mucus production and inflammation that can cause necrosis of these cells. The inflammation and increased secretions cause an obstruction in the lower airways that results in wheezing. The most common causative pathogen is respiratory syncytial virus, but other common viruses, including adenovirus, human metapneumovirus, influenza, and parainfluenza, can also cause it. A literature review was performed using the electronic search database PubMed. Keyword and mesh terms were used to define a set of literature discussing the use of high-flow nasal cannula versus continuous positive airway pressure in the management of viral bronchitis in pediatric patients. The search revealed 37 studies. All searches were narrowed down to the last five years. Studies that included nebulized, pharmacological treatments were excluded. There were ten studies that met the final criteria. The literature suggests that the use of CPAP for initial treatment had better success in not escalating support, but patients on CPAP typically had a longer length of stay. This could have been because if the patient had to be on CPAP, then they had more severe bronchiolitis. There is also the factor of the patient's discomfort with using CPAP. This could cause the need for some sedation to make them more comfortable with the device and also a need for weaning off the sedation. There was no difference in the intubation rate between the two support modes.

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