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La bronquiolitis es la enfermedad del tracto respiratorio más frecuente durante los dos primeros años de vida, que ocurre de forma epidémica durante el invierno y principio de la primavera. Su etiología es viral y el agente que con más frecuencia lo causa es el virus respiratorio sincitial (VRS). En la mayoría de los casos es una enfermedad benigna, de curso autolimitado, y sólo en ocasiones se requiere hospitalización.
En la práctica diaria, uno de los problemas a los que se enfrenta el pediatra es la falta de acuerdo acerca del correcto tratamiento farmacológico de la bronquiolitis, así como la ausencia de escalas clínicas sencillas y bien estandarizadas que faciliten el diagnóstico de gravedad. En este trabajo se pretende hacer una revisión de la bibliografía médica en lo referente a las escalas clínicas más utilizadas, así como en la eficacia terapéutica de los diferentes fármacos. A la luz de ellos se incluye un protocolo de tratamiento práctico de bronquiolitis en el que se recomienda la utilización de adrenalina inhalada para el tratamiento de la bronquiolitis moderada-grave del lactante hospitalizado, además de las medidas de soporte de oxigenoterapia y fluidoterapia.
Palabras clave:
Bronquiolitis
Virus respiratorio sincitial
Adrenalina
Protocolo
Lactantes
Bronchiolitis is the most frequent respiratory tract disease in the first 2 years of life. It occurs in epidemics in winter and spring. Etiology is viral and the most frequent causative agent is respiratory syncytial virus. In most patients the disease is benign and self-limiting and only occasionally requires hospitalization.
In daily clinical practice, one of the problems most frequently faced by the pediatrician is the lack of agreement on the correct pharmacological treatment of bronchiolitis, as well as the absence of simple, or standardized, clinical scores with which to diagnose severity. The present study provides a review of the medical literature on the most commonly used clinical scores and the therapeutic efficacy of the different drugs employed. A protocol for the practical management of bronchiolitis is provided. The use of inhaled adrenaline in the treatment of moderate- to-severe bronchiolitis in hospitalized infants, as well as oxygen and fluid therapy as support measures, are recommended.
Key words:
Bronchiolitis
Respiratory syncytial virus
Adrenaline
Protocol
Infants
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