Monitoring
Patient Monitoring
Cardiac and respiratory rate monitoring during the acute stage of the
disease must be considered, when the risk of apnea and/or bradycardia is
greatest. Once pulse and respiratory rate have been stabilized, monitoring may
be discontinued. Hourly SaO2 monitoring is recommended for patients
with moderate bronchiolitis. Patients <1 month old with history of apneic
episodes and prematurity should be monitored for apnea. Continuous
cardiorespiratory and SaO2 monitoring is recommended for patients
with severe bronchiolitis. Spot pulse oximetry checks are preferred for
patients showing clinical improvement. Continuous pulse oximetry monitoring may
be considered in patients showing severe symptoms of bronchiolitis upon
admission. Mechanical monitoring devices for heart rate, respiratory rate, and
SaO2 must be utilized discriminately, so that their use will not
result in failure to discharge the patient from the hospital in a timely
manner.
Suctioning
Secretions should be suctioned regularly, before feeding, prior to each
inhalational therapy, with the presence of signs of upper airway obstruction,
or as needed. It should be performed before measuring O2 saturation
in infants to avoid over-diagnosis of hypoxemia.
Discharge
Criteria
- Autonomy from any respiratory support with O2 saturation ≥93% in room air
- Clinically stable
- Adequate oral feeding and intake of fluids (75% of usual volume)
- Family unit able to monitor and administer therapy at home
- Local availability of pediatric health care