Acute viral bronchiolitis in South Africa: Intensive care management for severe disease

It is estimated that 2 - 3% of children will be hospitalised with viral bronchiolitis during their first year of life, and a small proportion ofthem will have a severe course of the disease, requiring intensive care and ventilatory support. In South Africa, 20% of children admittedto a paediatric intensive care unit (PICU) had positive respiratory viral isolates (especially respiratory syncytial virus), with symptomaticrespiratory disease. Rapid laboratory-based diagnosis using multiplex polymerase chain reaction is recommended to reduce overallantibiotic use in the PICU and neonatal ICU (NICU) and improve the targeted use of antibiotics (antibiotic stewardship). The mainstay ofbronchiolitis management in the PICU and NICU is supportive, comprising fluid management, oxygen supplementation and/or respiratoryventilatory support, and antipyretics if needed. Non-invasive nasal continuous positive airway pressure and high-flow nasal cannula oxygentherapy are increasingly being used in children with severe bronchiolitis, and may reduce the need for intubation. Infants with bronchiolitismay have a variety of clinical presentations, which may require different ventilatory approaches. Children may present predominantly withapnoeas, air trapping and wheeze, atelectasis and parenchymal disease (in acute respiratory distress syndrome), or a combination of these.Lung-protective ventilation, using a low tidal volume pressure-limited approach, is essential to limit ventilator-induced lung injury