PedsCrit Critical Bronchiolitis with Dr. Steve Shein and Dr. Jatinder Dhami
Oct 6, 2025
In this insightful discussion, Dr. Steve Shein, a leading expert in pediatric critical care, and Dr. Jatinder Dhami, a pediatric intensivist with a focus on ethics in critical illness, dive into the complexities of managing critical bronchiolitis. They explore why infants are particularly vulnerable to respiratory infections and the challenges of developing strong treatment guidelines. Delving into the merits of racemic epinephrine versus albuterol, they also emphasize the importance of monitoring physiologic stress and identifying when to escalate care. Their clinical insights are both engaging and informative!
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Don’t Anchor On ‘Bronchiolitis’
- Do broaden your differential for infants with presumed bronchiolitis, especially neonates and those with risk factors.
- Rule out sepsis, congenital heart disease, foreign body, and other uncommon causes when presentation is atypical.
Hidden Zebras Among Bronchiolitis Cases
- Steve Shein recalled cases billed as bronchiolitis that were actually abusive head trauma, inborn errors, or botulism.
- These real examples illustrate why intensivists must stay vigilant for atypical illnesses.
Syndrome, Not Single Disease
- Critical bronchiolitis lacks high-quality guidelines because definitions and terminology vary widely across studies.
- This heterogeneity has prevented building strong evidence for ICU-specific care pathways.