The American Academy of Pediatrics clinical practice guideline for bronchiolitis management recommends against treatment with bronchodilators, steroids, and hypertonic saline. The guideline recommends against supplemental oxygen for infants with oxygen saturation in room air. Yet pediatric health care personnel will turn to these therapies despite their negative value because of a need to “do something.”
To better understand why pediatricians still turn to unproven treatments, Marlow (Stanford) et al (10.1542/peds.2022-059939) share with us the results of a cross sectional survey administered to physicians, licensed practitioners (nurse practitioners or physician assistants), registered nurses (RNs), and respiratory therapists (RTs) in the Pediatric Research in Inpatient Settings (PRIS) national study network. The surveys presented a clinical vignette and a series of “what would you do” management questions.
Despite the lack of evidence, 54% of RN respondents and 45% of RTs would offer a patient albuterol compared to 2% of the physicians or licensed practitioners. Similar results were found for steroids, nebulized hypertonic saline, and deep but not superficial nasal suctioning. When it comes to offering supplemental in the absence of hypoxia, 52% of RNs, 32% of RTs, and even 23% of P/LPs would do so, potentially leading to oxygen toxicity or increased length of stay due to the increased need for monitoring.
The findings in this study suggest that education about ineffective treatments should include the whole care team and families. Share this study with all personnel you work with who care for infants with bronchiolitis to improve care and potentially decrease the length of stay.
