Lung ultrasound in the diagnosis and management of acute viral bronchiolitis; a systematic review

Objective: Acute viral bronchiolitis (AVB) is one of the most common viral infections and the most common lower respiratory tract infection in the first year of life. Current guidelines recommend that medical history and physical examination have the main role in the diagnosis of AVB. Lung ultrasound (LUS) has not been included in the diagnostic algorithm so far. The aim of this systematic review is to collect all available studies concerning the role of LUS in the diagnosis and management of AVB. Methods: PubMed - MEDLINE, Scopus and ScienceDirect databases were searched for trials reporting on LUS examination in the diagnosis and management of AVB in paediatric patients. Results: A total of seventeen studies matching our eligibility criteria were analyzed for the purposes of this review and their results were categorized into six major fields each one of them answering to a question. There are several LUS scores that evaluate the severity of sonographic findings in children with AVB. The findings on LUS and chest radiography are comparable and LUS has a significant role in further management of AVB in the Paediatric Emergency Department. LUS score is correlated to the clinical course of AVB and it can predict both the duration of hospitalization and the need for respiratory support. Conclusion: Current literature supports that LUS could have comparable efficiency with chest radiography concerning the diagnosis of AVB and it could predict the length of hospital stay and the need of oxygen supply.

The use of the thoracic-abdominal rebalancing technique in a patient with acute viral bronchiolitis: an experimental report

Acute Viral Bronchiolitis (AVB) commonly affects newborns and infants causing signs of mild to moderate respiratory distress, presenting in some cases, need of hospital care to these patients. Thus, despite the low evidence levels of indicating the use of conventional therapies while treating BVA, this article presents the effectiveness of the Thoracic-Abdominal Rebalancing (TAR) technique in a newborn diagnosed with BVA during his hospital stay. The ATR technique proved to be effective in improving signs of respiratory effort when used in an infant hospitalized for AVB.

Measurement of the interbronchial angle in acute viral bronchiolitis

Acute viral bronchiolitis (AVB) is the most common infection of the lower airways in children under 2 years of age. Attempts to determine the severity of the disease based on clinical and radiological manifestations are a major challenge. Measurements of the anatomy of the trachea, main bronchi and bronchioles are not limited to pure anthropometry, but are also useful for better knowledge and applicability in pulmonary physiology, thoracic surgery, anesthesiology and in the care of critically ill patients. This is a cross-sectional, retrospective study, which included all patients admitted to a tertiary hospital in the city of Porto Alegre, over a period of one year, with a diagnosis of AVB. The interbronchial angle (ITB) of these patients was measured and clinical and epidemiological characteristics were analyzed. A total of 425 patients were included, diagnosed with BVA by respiratory syncytial virus (RSV) confirmed by immunofluorescence. Most of these patients were male (59.5%) and the median age was 130 days, 91.11% of them required oxygen therapy through a nasal catheter, 3.3% used non-invasive ventilation (NIV) and 4% mechanical ventilation (MV) . Among the studied patients, we obtained only one death (0.2%). Those who required MV or NIV and support in an intensive care unit were considered serious. The mean ITB was lower for these patients than for less severe ones. It is concluded that the ABI has a correlation with the prognosis of patients with AVB and, after further studies, can be used as a severity score.