Pediatría Atención Primaria
versión impresa ISSN 1139-7632
GONZALEZ DE DIOS, J.; OCHOA SANGRADOR, C. y GRUPO DE TRABAJO (GRUPO INVESTIGADOR, GRUPO DE REVISION Y PANEL DE EXPERTOS) DEL PROYECTO ABREVIADO (BRONQUIOLITIS-ESTUDIO DE VARIABILIDAD, IDONEIDAD Y ADECUACION). Recommendations of the Consensus Conference of Acute Bronchiolitis in Spain: from evidence to practice. Rev Pediatr Aten Primaria [online]. 2010, vol.12, suppl.19, pp.s107-s128. ISSN 1139-7632.
The methodology (literature review, evidence synthesis, method of consensus and strength of recommendations) and recommendations of the Consensus Conference are presented. The evidence on the frequency of bronchiolitis in the general population and risk groups, risk factors and markers of severe forms, scores of severity and clinical-etiological profile is summarized. The commonly used diagnostic tests are ineffective in the management of the disease; oxygen saturation measurement is considered necessary only in the initial assessment or control of changes in patients with respiratory distress. Other tests (chest radiograph, rapid diagnostic tests for respiratory virus infection and screening tests for bacterial infection) should be used only very selectively. There is sufficient evidence on the lack of effectiveness of most interventions tested in bronchiolitis. Apart from oxygen therapy, fluid therapy, aspiration of secretions and ventilation support, few treatment options will be beneficial. Only in moderate-severe bronchiolitis would be justified to test a treatment with inhaled bronchodilators (salbutamol or epinephrine) with or without hypertonic saline solution. In cases with respiratory failure could be used heliox and noninvasive ventilation techniques, methylxanthine in patients with apnea and surfactant in intubated critically ill patients. No treatment has proved effective in preventing persistence or recurrence of postbronchiolitis symptoms. Regarding the prevention of bronchiolitis, only palivizumab reduces the risk of admissions for lower respiratory infections by respiratory syncytial virus, although its high cost justifies its use only in a small group of high-risk patients.
Palabras clave : Viral bronchiolitis; Systematic review; Consensus development conference; Evidence-based medicine; Pediatrics.