E222: “Pandemic Immunity Gap?” - Managing Acute Respiratory Compromise in RSV

The "Pandemic Immunity Gap" is likely behind the massive surge in respiratory syncytial virus (RSV), with current CDC data showing a 275% increase from 2020-2021 to 2022-2023. The most vulnerable population is between 0-6 months old, which often raises the stress level for providers across all spectrums. Join Eric for a deep dive into a case study involving a 4-month-old male in acute respiratory compromise. We break down the progression of RSV and its association with bronchiolitis. Dive deep into the current evidence on fluid management, bronchodilators, corticosteroids, NS 0.9%, Hypertonic 3%, racemic epinephrine, HFNC, NiPPV, intubation, and much more. 

Recommended flow settings and cannula sizes for high-flow nasal cannula therapy in pediatric patients https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027347/table/t1-kjp-2019-00626/?report=objectonly

Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma: Hosp Pediatr (2017) 7 (7): 403–409. https://doi.org/10.1542/hpeds.2016-0211

Efficacy of 3% hypertonic saline in bronchiolitis: A meta‑analysis,  Received May 10, 2018; Accepted August 22, 2018. DOI: 10.3892/etm.2019.7684

Respiratory syncytial virus: diagnosis, prevention and management: Ther Adv Infectious Dis 2019, Vol. 6: 1–9 DOI: 10.1177/2049936119865798

https://journals.sagepub.com/doi/epdf/10.1177/2049936119865798

Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2010;12CD001266.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001266.pub4/full

Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis

https://www.bmj.com/content/342/bmj.d1714

High-dose inhaled corticosteroids’ effect on wheezing in infants after respiratory syncytial virus infection: a randomized, double-blind placebo-controlled trial.

Ermers MJ, Rovers MM, van Woensel JB, Kimpen JL, Bont LJ; RSV Corticosteroid Study Group. High-dose inhaled corticosteroids’ effect on wheezing in infants after respiratory syncytial virus infection: a randomized, double-blind placebo-controlled trial. BMJ. 2009;338:b897.

Heliox inhalation therapy for bronchiolitis in infants

Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev. 2010;4:CD006915.