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La bronquiolitis es la infección respiratoria más frecuente durante la lactancia, y causa de una morbilidad significativa. Se ha avanzado poco en su tratamiento, y es en numerosos casos la terapia empleada controvertida, y apoyada fundamentalmente en recomendaciones generales y no en estrategias basadas en la evidencia. En la presente revisión se han analizado las pruebas disponibles sobre el tratamiento de la bronquiolitis aguda (entendida como un primer episodio de bronquiolitis aguda por virus respiratorio sincitial en un lactante menor de 12 meses sin enfermedad previa), siguiendo la metodología de la medicina basada en la evidencia. Tras el análisis efectuado se concluye que las únicas intervenciones terapéuticas justificables en estos pacientes son el tratamiento de soporte, la adrenalina nebulizada y la ventilación mecánica. Medidas terapéuticas como fisioterapia, nebulización, heliox o surfactante, entre otras, requieren nuevos estudios aleatorizados controlados que definan mejor su utilidad. No existen evidencias que sustenten el uso de corticoides, betaadrenérgicos, antibióticos, inmunoglobulinas, interferón, vitamina A o ribavirina en este grupo de pacientes. Finalmente, creemos que sería interesante la realización de una revisión de consenso nacional para la implementación de guías prácticas clínicas “basadas en la evidencia„ sobre el tratamiento de la bronquiolitis aguda.
Palabras clave:
Lactante
Revisión
Medicina basada en la evidencia
Bronquiolitis aguda
Virus respiratorio sincitial
Tratamiento
Recomendaciones prácticas
Bronchiolitis is the leading cause of lower respiratory tract infection in infants and produces significant morbidity. Limited progress has been made in the treatment of this disease and, in many cases, the therapy employed is controversial and mainly based on general recommendations and not on evidence-based strategies. This report uses evidence-based methodology to provide a critical review of the data available on the treatment of acute bronchiolitis (understood as the first episode of respiratory syncytial virus bronchiolitis in a previously healthy infant). After this analysis, we conclude that the only justifiable therapeutic interventions in these patients are supportive treatment, nebulized epinephrine and mechanical ventilation. Other therapies such us physiotherapy, nebulization, heliox, anticholinergics or exogenous surfactant, among others, require further randomized controlled trials to determine their utility. No evidence supports the routine use of corticosteroids, beta-adrenergic drugs, antibiotics, immunoglobulins, interferon, vitamin A or ribavirin in these patients. Finally, we consider that a national consensus review for the implementation of evidence-based clinical practical guidelines on the management of acute bronchiolitis would be of great interest.
Key words:
Infant
Review
Evidence-based medicine
Acute bronchiolitis
Respiratory syncytial virus
Treatment
Practice guidelines
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Bibliografía
[2.]
M.L. Everard.
Acute Bronchiolitis and pneumonia in infancy resulting from respiratory syncytial virus.
Pediatric respiratory medicine, pp. 580-595
[3.]
M.E.B. Wohl.
Bronchiolitis.
Kendig’s disorders of the respiratory tract in children, pp. 473-485
[4.]
Sitio web: Centres for Health Evidence.net. En: www.cchet.net
[5.]
V.A. Moyer.
BMJ Books, (2000),
[6.]
Sackett DL. Levels of evidence and grades of recommendation. Disponible en: http://cebm.jr2.ox.ac.uk/docs/levels.html
[7.]
G.H. Guyyatt, D.L. Sackett, D.J. Cook.
Users’guides to the medical literature: II. How to use an article about therapy or prevention.Are the results of the study validα Evidence-Based Medicine Working Group.
JAMA, 270 (1993), pp. 2598-2601
[8.]
G.H. Guyatt, D.L. Sackett, D.J. Cook.
Users’ guides to the medical literature: II. How to use an article about therapy or prevention. What were the results and will they help me in caring for my patientsα Evidence-Based Medicine Working Group.
JAMA, 271 (1994), pp. 59-63
[9.]
E.O.R. Reynolds, C.D. Cook.
The treatment of bronchiolitis.
J Pediatr, 6 (1963), pp. 1205-1207
[10.]
E.O.R. Reynolds.
Arterial blood gas tensions in acute disease of lower respiratory tract infections.
Br Med J, 2 (1963), pp. 1192-1195
[11.]
C.B. Hall, W.J. Hall, D.M. Speers.
Clinical and physiological mani-festations of bronchiolitis and pneumonia.
Am J Dis Child, 133 (1979), pp. 798-802
[12.]
H. Simpson, D.J. Matthew, J.M. Inglis, E.L. George.
Virological findings and blood gas tensions in acute lower respiratory tract infections in children.
Br Med J, 2 (1964), pp. 629-632
[13.]
F.J. Pilar Orive, J. Casado Flores, M.A. García Teresa, A. RodríguezNúñez, E. Quiroga Ordóñez, F. Cambra Lasaosa.
Infecciones respiratorias agudas en Unidades de Cuidados IntensivosPediátricos. Estudio prospectivo multicéntrico.
An EspPediatr, 48 (1998), pp. 138-142
[14.]
J.L. Kimpen, U.B. Schaad.
Treatment of respiratory syncytial virusbronchiolitis: 1995 poll of members of the European Society forPaediatric Infectious Diseases.
Pediatr Infect Dis J, 16 (1997), pp. 479-481
[15.]
R.A. Lugo, M. Nahata.
Pathogenesis and treatment of bronchioli-tis.
Clin Pharm, 12 (1993), pp. 95-116
[16.]
M.J. Makela, O. Ruuskanen, P.L. Ogra.
Treatment of respiratorysyncytial virus infections in children.
Ann Med, 26 (1994), pp. 341-343
[17.]
L.M. Taussig.
Mists and aerosols: new studies, new thoughts.
J Pediatr, 84 (1974), pp. 619-622
[18.]
A.L. Porter.
Physiotherapy in the treatment of bronchiolitis and bronchopneumonia in babies and young children.
Physiotherapy, 53 (1967), pp. 333-335
[19.]
M.S. Webb, J.A. Martin, P.H. Cartlidge, Y.K. Ng, N.A. Wright.
Chest physiotherapy in acute bronchiolitis.
Arch Dis Child, 60 (1985), pp. 1078-1079
[20.]
G.G. Viviano, A. Reale, M. Iannelli.
Validity and limitations of res-piratory physiotherapy in children.
Pediatr Med Chir, 12 (1990), pp. 155-156
[21.]
J.D. Kellner, A. Ohlsson, A.M. Gadomski, E.E.L. Wang.
Bronchodilators for bronchiolitis.
The Cochrane Library, Issue 1,
[22.]
G. Flores, R.I. Horwitz.
Efficacy of beta 2-agonists in bronchiolitis: A reappraisal and meta-analysis.
Pediatrics, 100 (1997), pp. 233-239
[23.]
A.M. Gadomski, R. Lichenstein, L. Horton, J. King, V. Keane, T. Permutt.
Efficacy of albuterol in the management of bronchiolitis.
Pediatrics, 93 (1994), pp. 907-912
[24.]
L. Ho, G. Collins, L.I. Landau, P. Le Souef.
Effect of salbutamol on oxygen saturation in bronchiolitis.
Arch Dis Child, 66 (1991), pp. 1061-1064
[25.]
C. O’Callaghan, A.D. Milner, A. Swarbrick.
Paradoxical deteriora-tion in lung function after nebulised salbutamol in wheezy infants.
Lancet, 2 (1986), pp. 1424-1425
[26.]
A. Prendeville, S. Green, M. Silverman.
Paradoxical response to nebulised salbutamol in wheezy infants, assessed by partial expiratory flow-volume curves.
Thoras, 42 (1987), pp. 86-91
[27.]
A. Rodríguez Núñez, F. Martinón-Torres, J.M. Martinón Sánchez.
Empleo de corticoides y broncodilatadores en el lactante con bronquiolitis.
An Esp Pediatr, 128 (1999), pp. S24-26
[28.]
R.A. Lugo, J.W. Salyer, J.M. Dean.
Albuterol in acute bronchiolitiscontinued therapy despite poor response?.
Pharmacotherapy, 18 (1998), pp. 198-202
[29.]
S. Kristjansson, K.C. Lodrup Carlsen, G. Wennergren, I.L. Strannegard, K.H. Carlsen.
Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers.
Arch Dis Child, 69 (1993), pp. 650-654
[30.]
K. Menon, T. Sutcliffe, T.P. Klassen.
A randomized trial comparing the efficacy of epinephrine with salbutamol int the treatment for bronchiolitis.
J Pediatr, 126 (1995), pp. 1004-1007
[31.]
T. Reijonen, M. Korppi, S. Pitkakangas, S. Tenhola, K. Remes.
Theclinical efficacy of nebulized racemic epinephrine and albuterol in acute bronchiolitis.
Arch Pediatr Adolesc Med, 149 (1995), pp. 686-692
[32.]
D.I. Lowell, G. Lister, H. Von Koss, P. McCarthy.
Wheezing in infants: The response to epinephrine.
Pediatrics, 79 (1987), pp. 939-945
[33.]
P. Bertrand, H. Aranibar, E. Castro, I. Sanchez.
Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis.
Pediatr Pulmonol, 31 (2001), pp. 284-288
[34.]
I. Sanchez, J. De Koster, R.E. Powell, R. Wolstein, V. Chernick.
Effect of racemic epinephrine and salbutamol on clinical scoreand pulmonary mechanics in infants with bronchiolitis.
J Pediatr, 122 (1993), pp. 145-151
[35.]
K.C. Lodrup Carlsen, K.H. Carlsen.
Inhaled nebulized adrenaline improves lung function in infants with acute bronchiolitis.
Respir Med, 94 (2000), pp. 709-714
[36.]
S. Schuh, D. Johnson, G. Canny, J. Reissman, M. Shields, T. Kovesi.
Efficacy of adding nebulized ipratropium bromide to nebulized albuterol therapy in acute bronchiolitis.
Pediatrics, 90 (1992), pp. 920-923
[37.]
B.K. Rubin, G.M. Albers.
Use of anticholinergic bronchodilaton in children.
Am J Med, 100 (1996), pp. 49-53
[38.]
J. Seidenberg, I.B. Masters, A. Olinsky, P.D. Phelan.
Effect of ipratropium bromide on respiratory mechanics in infants withacute bronchiolitis.
Aust Paediatr J, 23 (1987), pp. 169-172
[39.]
R.L. Henry, A.D. Milner, G.M. Stokes.
Ineffectiveness of ipatropium bromide in acute bronchiolitis.
Arch Dis Child, 58 (1983), pp. 925-926
[40.]
L.P. Sammartino, D. Lines.
Efficacy of ipratropium bromide by metered dose aerosol and aerochamber in acute paediatri bronchiolitis.
J Paediatr Child Health, 33 (1997), pp. 459
[41.]
E.E.L. Wang, R. Milner, U. Allen, H. Maj.
Bronchodilators for treatment of mild bronchiolitis: a factorial randomised trial.
Arch Dis Child, 67 (1992), pp. 289-293
[42.]
M.L. Everard, A. Bara, M. Kurian.
Anticholinergic drugs for wheeze in children under the age of two years (Cochrane Review).
The Cochrane Library, issue 1,
[43.]
B.J. Lipworth.
Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis.
Arch Intern Med, 159 (1999), pp. 941-955
[44.]
D.B. Allen, M. Mullen, B. Mullen.
A meta-analysis of the effect of oral and inhaled corticosteroids on growth.
J Allergy Clin Immunol, 93 (1994), pp. 967-976
[45.]
J.H. Connolly, C.M. Field, J.F. Glasgow, C.M. Slattery, D.M. MacLynn.
A double blind trial of prednisolone in epidemic bronchiolitis due to respiratory syncytial virus.
Acta Paediatr Scand, 58 (1969), pp. 116-120
[46.]
K. De Boeck, N. Van der Aa, S. Van Lierde, L. Corbeel, R. Eeckels.
Respiratory syncytial virus bronchiolitis: a double-blind dexamethason efficacy study.
J Pediatr, 131 (1997), pp. 919-921
[47.]
H. Richter, P. Seddon.
Early nebulized budesonide in the treatment of bronchiolitis and the prevention of postbronchiolitic wheezing.
J Pediatr, 132 (1998), pp. 849-853
[48.]
A. Cade, K.G. Brownlee, S.P. Conway.
Randomised placebo-con-trolled trial of nebulised corticosteroids in acute respiratory syncytial viral bronchiolitis.
Arch Dis Child, 82 (2000), pp. 126-130
[49.]
S.M. Bulow, M. Nir, E. Levin.
Prednisolone treatment for respiratory syncytial virus infection: a randomized controlled trial of 147 infants.
Pediatrics, 104 (1999), pp. 77
[50.]
J.A. Leer, J.L. Green, E.M. Heimlich, J.S. Hyde, H.L. Moffet, G.A. Young, et al.
Corticosteroid treatment in bronchiolitis. A controlled collaborative study in 297 infants and children.
Am J Dis Child, 117 (1969), pp. 495-503
[51.]
A. Tal, C. Bavilski, D. Yohai, J.E. Bearman, R. Gorodischer, S.W. Moses.
Dexamethasone and salbutamol in the treatment of acute wheezing in infants.
Pediatrics, 71 (1983), pp. 13-18
[52.]
J.Y. Wong, S. Moon, C. Beardsmore, C. O’Callaghan, H. Simpson.
No objective benefit from steroids inhaled via a spacer in infants recovering from bronchiolitis.
Eur Respir J, 15 (2000), pp. 388-394
[53.]
I. Berger, Z. Argaman, S.B. Schwartz.
Efficacy of corticosteroids in acute bronchiolitis: short-term and long-term follow-up.
Pediatr Pulmonol, 26 (1998), pp. 162-166
[54.]
G. Roosevelt, K. Sheehan, J. Grupp-Phelan, R.R. Tanz, R. Listernick.
Dexamethasone in bronchiolitis: a randomised controlled trial.
Lancet, 348 (1996), pp. 292-295
[55.]
T.P. Klassen, T. Sutcliffe, L.K. Watters, G.A. Wells, U.D. Allen, M.M. Li.
Dexamethasone in salbutamol-treated inpatients with acute bronchiolits: a randomized, controlled trial.
J Pediatr, 130 (1997), pp. 191-196
[56.]
M.M. Garrison, D.A. Christakis, E. Harvey, P. Cummings, R.L. Davis.
Systemic corticosteroids in infant bronchiolitis: A meta-analysis.
Pediatrics, 105 (2000), pp. 849
[57.]
H. Patel, R. Platt, J.M. Lozano, E.E.I. Wang.
Glucocorticoids in hospitalized infants and young children with acute viral bronchiolitis (protocol).
The Cochrane Library, Issue 1,
[58.]
C.B. Hall, K.R. Powell, K.C. Schnabel, C.L. Gala, P.H. Pincus.
Risk of secondary bacterial infection in infants hospitalized with RSVinfection.
J Pediatr, 113 (1988), pp. 266-271
[59.]
N. Kuppermann, D.E. Bank, E.A. Walton, M.O. Senac, I. McCaslin.
Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis.
Arch Pediatr Adolesc Med, 151 (1997), pp. 1207-1214
[60.]
H.D. Davies, K.R. Matlow, M. Petric, R. Glazier, E.E.L. Wang.
Prospec-tive comparative study of viral, bacterial, and atypical organism identified in pneumonia and bronchiolitis in hospitalized Cana-dian infants.
Pediatr Infect Dis J, 15 (1996), pp. 371-375
[61.]
M. Henderson, E. Rubin.
Misuse of antimicrobials in children with asthma and bronchiolitis.
Pediatr Infect Dis J, 20 (2001), pp. 214-215
[62.]
P.M. Adcock, C.L. Sanders, G.S. Marshall.
Standardizing the care of bronchiolitis.
Arch Pediatr Adolesc Med, 152 (1998), pp. 739-744
[63.]
L. Samson, C. Cooke, N. Macdonald.
Analysis of antibiotic use and misuse in children hospitalized with RSV infection.
Pae-diatr Child Health, 4 (1999), pp. 195-199
[64.]
E.E. Wang, B.J. Law, D. Stephens.
Pediatric Investigators Collaborative Network on Infectons in Canada (PICNIC) prospective study of risk factors and outcomes in patients hopitalized with respiratory syncytial virus infection.
Pediatrics, 92 (1993), pp. 501-504
[65.]
B. Friis, P. Andersen, E. Brenöe, A. Hornsleth, A. Jensen, F.U. Knudsen, et al.
Antibiotic treatment of pneumonia and bronchiolitis: a prospective randomized study.
Arch Dis Child, 59 (1984), pp. 2038-2045
[66.]
A. Labbé.
Antibiotiques et antiviraux.
Arch Pediatr, 8 (2001), pp. 95-97
[67.]
C.M. Field, J.H. Connolly, G. Murtagh, C.M. Slattery, E.E. Turkington.
Antibiotic treatment of epidemic brochiolitis a double-blind trial.
Br Med J, 5479 (1966), pp. 83-85
[68.]
A.G. Randolph, E.E.L. Wang.
Update Software, (2000),
[69.]
A.M. Guerguerian, M. Gauthier, M.H. Lebel, C.A. Farrell, J. Lacroix.
Ribavirin in ventilated respiratory syncytial virus bronchiolitis.
Am J Respir Crit Care Med, 160 (1999), pp. 829-834
[70.]
D. Edell, E. Bruce, K. Hale, V. Khoshoo.
Reduced long-term res-piratory morbidity after treatment of respiratory syncytial virus bronchiolitis with ribavirin in previously healthy infants: a pre-liminary report.
Pediatr Pulmonology, 25 (1998), pp. 154-158
[71.]
C.E. Long, K.Z. Voter, W.H. Barker, C.B. Hall.
Long term follow-up of children hospitalized with respiratory syncytial virus lower respiratory tract infection and randomly treated with ribavirin or placebo.
Pediatr Infect Dis J, 16 (1997), pp. 1023-1028
[72.]
E.M. Johnson.
Developmental toxicity and safety evaluations of ribavirin.
Pediatr Infect Dis J, 9 (1997), pp. S85-S87
[73.]
F. Martinón-Torres, A.R. Núñez, J.M. Martinón.
Heliox: Perspecti-vas de aplicación en pediatría.
An Esp Pediatr, 128 (1999), pp. 42S-45S
[74.]
Martinón-Torres F. Otros modos de terapia respiratoria: Heliox.>En: Ruza Tarrío F, ed. Tratado de Cuidados Intensivos Pediatri-cos. Madrid: Norma-Capitel, 2001. En prensa
[75.]
G. Hollman, G. Shen, L. Zeng, R. Yngsdal-Krenz, W. Perloff, J. Zim-merman.
Helium-oxygen improves Clinical AsthmaScores in children with acute bronchiolitis.
Crit Care Med, 26 (1998), pp. 1731-1736
[76.]
F. Martinón-Torres, M. Picón Cotos, S. Fernández Cebrián, A. Rodrí-guez Núñez.
Heliox: Una nueva opción terapéutica en la bron-quiolitis aguda [resumen].
An Esp Pediatr, 54 (2001), pp. 32-33
[77.]
E.E.L. Wang, N.K. Tang.
Oxford, (1991),
[78.]
W.J. Rodriguez, W.C. Gruber, R.C. Welliver, J.R. Groothuis, E.A. Simoes, H.C. Meissner.
Respiratory syncytial virus (RSV) immune globulin intravenous therapy for RSV lower respira-tory tract infection in infants and young children at high risk for severe RSV infections.
Pediatrics, 99 (1997), pp. 454-461
[79.]
W.J. Rodriguez, W.C. Gruber, J.R. Groothuis, E.A. Simoes, A.J. Rosas, M. Lepow.
Respiratory syncytial virus immune globulin treatment of RSV lower respiratory tract infection in previousl healthy children.
Pediatrics, 100 (1997), pp. 937-942
[80.]
V.G. Hemming, W. Rodriguez, H.W. Kim, C.D. Brandt, R.H. Parrot, B. Burch.
Intravenous immunoglobulin treatment of respiratory syncytial virus infections in infants and young children.
Antimicrob Agents Chemother, 31 (1987), pp. 1882-1886
[81.]
P.C. Rimensberger, A. Burek-Kozlowska, A. Morell, D. Germann, A.K. Eigenmann, F. Steiner.
Aerosolized immunoglobulin treatment of respiratory syncytial virus infection in infants.
Pediatr Infect Dis J, 15 (1996), pp. 209-216
[82.]
D. Tan, E. Wang, A. Ohlsson.
Update Software, (2001),
[83.]
G.A. Prince, A. Mathews, S.J. Curtis, D.D. Porter.
Treatment of respiratory syncytial virus bronchiolitis and pneumonia in a cotton rat model with sistemically administered monoclonal antibody (Palivizumab) and glucocortiscosteroid.
J Infect Dis, 182 (1991), pp. 1326-1330
[84.]
R. Malley, J. DeVincenzo, O. Ramilo, P.H. Dennehy, H.C. Meissner, W.C. Gruber.
Reduction of respiratory syncytial virus (RSV) in tracheal aspirates in intubated infants by use of humanized monoclonal antibody to RSV F protein.
J Infect Dis, 178 (1998), pp. 1555-1561
[85.]
K.P. Quinlan, K.C. Hyani, A. Vitamin.
Vitamin A and respiratory syncytial virus infection.
Arch Pediatr Adolesc Med, 150 (1996), pp. 25-30
[86.]
C.B. Pinnock, R.M. Douglas, A.J. Martin, N.R. Badcock.
Vitamin A status of children with a history of respiratory syncytial virus infection in infancy.
Aust Paediatr J, 24 (1988), pp. 286-289
[87.]
K.M. Neuzil, W.C. Gruber, F. Chytil, M.T. Stahlman, B. Engelhardt, B.S. Graham.
Serum vitamin A levels in respiratory syncytial virus infection.
J Pediatr, 124 (1994), pp. 433-436
[88.]
S.F. Dowell, Z. Papic, J.S. Bresee, C. Larrananaga, M. Mendez, A.L. Sowell.
Treatment of respiratory syncytial virus infec-tion with vitamin A: A randomized, placebo-controlled trial in Santiago. Chile.
Pediatr Infect Dis J, 15 (1996), pp. 782-786
[89.]
C.L. Kjolhede, F.J. Chew, A.M. Gadomski, D.P. Marroquin.
Clinical trial of vitamin A as adjuvant treatment for lower respiratory tract infections.
J Pediatr, 126 (1995), pp. 807-812
[90.]
J.S. Bresee, M. Fischer, S.F. Dowell, B.D. Jonhston, V.M. Biggs, R.S. Levine.
Vitamin A therapy for children with respiratory syncytial virus infection: a multicenter trial in the United States.
Pediatr Infect Dis J, 15 (1996), pp. 777-782
[91.]
Y.H. Wang, K.J. Xu, W.S. Jiang.
Experimental and clinical study of shuanghuanglian aerosol in treating acute respiratory tract infections.
Zhongguo Zhong Xi Yi Jie He Za Zhi, 15 (1995), pp. 347-350
[92.]
X.T. Kong, H.T. Fang, G.O. Jiang, S.Z. Zhai, D.L. O’Conell, D.R. Brewster.
Treatment of acute bronchiolitis with Chinese herbs.
Arch Dis Child, 68 (1993), pp. 468-471
[93.]
R. Ma.
Antiviral and interferon-inducing effect of fang-gan mixture.
Zhong Xi Yi Jie He Za Zhi, 10 (1990), pp. 222-224
[94.]
C. Liu, R.M. Douglas.
Chinese herbal medicines in the treatment of acute respiratory infections: a review of randomized con-trolled clinical trials.
Med J Aust, 169 (1998), pp. 579-582
[95.]
D. Isaacs.
Production of interferon in respiratory syncytial virus bronchiolitis.
Arch Dis Child, 64 (1989), pp. 92-95
[96.]
B.E. Chipps, W.F. Sullivan, J.M. Portnoy.
Alpha-2a interferon for treatment of bronchiolitis caused by respiratory syncytial virus.
Pediatr Infect Dis J, 12 (1993), pp. 653-658
[97.]
R.Y. Sung, S.J. Oppenheimer, J.S. Tam, J. Lau.
Treatment of respiratory syncytial virus infection with recombinant interferon alfa-2.
Arch Dis Child, 69 (1993), pp. 440-442
[98.]
P.G. Higgings, G.I. Barrow, D.A. Tyrrell, D. Isaacs, C.L. Gauci.
The efficacy of intranasal interferon alpha-2a in respiratory sycytial virus infection.
Antiviral Res, 14 (1990), pp. 3-10
[99.]
J. Portnoy, R. Hicks, F. Pacheco, L. Olson.
Pilot study of recombinant interferon alpha-2a for treatment of infants with bronchiolitis induced by respiratory syncytial virus.
Antimicrob Agents chemother, 32 (1988), pp. 589-591
[100.]
L.J. Brooks, G.J. Cropp.
Theophylline therapy in bronchiolitis. A retrospective study.
Am J Dis Child, 135 (1981), pp. 934-936
[101.]
A. Labbe, P. Billet, M. Paire, B. Storme, B. Sablayrolles, P. Vanliefe-ringhen, et al.
Treatment of acute bronchiolitis in infants by oral suspension theophylline. Double-blind study in 62 children.
Pediatrie, 40 (1985), pp. 195-199
[102.]
M.J. Tobin.
McGraw-Hill, (1984),
[103.]
W.J. Soong, B. Hwang, R.B. Tang.
Continuous positive airway pressure by nasal prongs in bronchiolitis.
Pediatr Pulmonol, 16 (1993), pp. 163-166
[104.]
J.M. Beasley, S.E. Jones.
Continuous positive airway pressure in bronchiolitis.
Br Med J, 283 (1981), pp. 1506-1508
[105.]
L.R. Frankel, N.J. Lewiston, D.W. Smith, D.K. Stevenson.
Clinical observations on mechanical ventilation for respiratory failure in bronchiolitis.
Pediatr Pulmonol, 2 (1986), pp. 307-311
[106.]
P.G. Smith, M.F. El-Khatib, W.A. Carlo.
PEEP does not improve pulmonary mechanics in infants with bronchiolitis.
Am Rev Respir Dis, 147 (1993), pp. 1295-1298
[107.]
B. Krafte-Jacobs, P.R. Holbrook.
Ribavirin in severe respiratory syncytial virus infection.
Crit Care Med, 22 (1994), pp. 541-543
[108.]
K.M. Outwater, R.K. Crone.
Management of respiratory failure in infants with acute viral bronchiolitis.
Am J Dis Child, 138 (1984), pp. 1071-1075
[109.]
D.V. Tuxen.
Permissive hypercapnic ventilation.
Am J Respir Crit Care Med, 150 (1994), pp. 870-874
[110.]
T. Hoehn, M. Krause, M. Krueger, R. Hentschel.
Treatment of respiratory failure with inhaled nitric oxide and high-fre-quency ventilation in an infant with respiratory syncytial virus pneumonia and bronchopulmonary dysplasia.
Respiration, 65 (1998), pp. 477-480
[111.]
S. Medbo, P.H. Finne, T.W. Hansen.
Respiratory syncytial virus pneumonia ventilated with high-frequency oscillatory ventila-tion.
Acta Paediatr, 86 (1997), pp. 766-768
[112.]
E.L. Duval, P.L. Leroy, R.J. Gemke, A.J. Van Vaught.
High-fre-quency oscillatory ventilation in RSV bronchiolitis patients.
Respir Med, 93 (1999), pp. 435-440
[113.]
F. Martinón-Torres, A. Rodríguez Núñez, J.M. Martinón Sánchez.
Tratamiento de la infección severa por virus respiratorio sinci-tial con ventilación de alta frecuencia oscilatoria [resumen].
Esp Pediatr, 54 (2001), pp. 166-167
[114.]
J.Y. Khan, S.J. Kerr, A. Tometzki, L. Tyszczuk, J. West, A. Sosnowski.
Role of ECMO in the treatment of respiratory syncytial virus bronchiolitis: a collaborative report.
Arch Dis Child Fetal Neonatal Ed, 73 (1995), pp. 91-94
[115.]
T.A. Meyer, B.W. Warner.
Extracorporeal life support for the treatment of viral pneumonia: collective experience from the ELSO registry. Extracorporla Life Support Organization.
J Pediatr Surg, 32 (1997), pp. 232-236
[116.]
Steinhorn RH, Green TP. Use of extracorporeal membrane oxygenation in the treatment of respiratory syncytial virus bronchiolitis: the national experience, 1983-1988. J Pediatr 1990; 338-342
[117.]
M.H. Kerr, J.Y. Paton.
Surfactant protein levels in severe respiratory syncytial virus infection.
Am J Respir Crit Care Med, 159 (1999), pp. 1115-1118
[118.]
R. Skelton, P. Holland, M. Darowski, P.A. Chetcuti, L.W. Morgan, J.L. Harwood.
Abnormal surfactante composition and activity in severe bronchiolitis.
Acta Paediatr, 88 (1999), pp. 942-946
[119.]
T.P. Hickling, R. Malhortra, H. Bright, W. McDowell, E.D. Blair, R.B. Sim.
Lung surfactant protein A provides a route of entry for respiratory syncytial virus into host.
Viral Immunol, 13 (2000), pp. 125-135
[120.]
S.Z. Wang, I.R. Doyle, T.E. Nicholas, K.D. Forsyth.
Plasma surfactant protein B is elevated in infants with respiratory syncytial virus-induced bronquiolitis.
Pediatr Res, 46 (1999), pp. 731-734
[121.]
S.M. Tibby, M. Hatherill, S.M. Wright, P. Wilson, A.D. Postle, I.A. Murdoch.
Exogenous surfactant supplementation in infants with respiratory syncytial virus bronchiolitis.
Am J Respir Crit Care Med, 162 (2000), pp. 1251-1256
[122.]
M. Luchetti, G. Casiraghi, R. Valsecchi, E. Galassini, G. Marraro.
Porcine-derived surfactant treatment of severe bronchiolitis.
. Acta Anaesthesiol Scand, 42 (1998), pp. 805-810
[123.]
A. Greenough.
Expanded use of surfactant replacement therapy.
Eur J Pediatr, 159 (2000), pp. 635-640
[124.]
D. Fitzgerald, G. Davis, C. Rohlicek, R. Gottesman.
Quantifying pulmonary hypertension in ventilated infants with bronchiolitis: a pilot study.
J Paeditr Child Health, 37 (2001), pp. 64
[125.]
N.R. Patel, J. Hammer, S. Nichani, A. Numa, C.J. Newth.
Effect of inhaled nitric oxide on respiratory mechanics in ventilated infants with RSV bronchiolitis.
Intensive Care Med, 25 (1999), pp. 81-87
[126.]
H.P. Van Bever, K.N. Desager, J.H. Pauwels, M. Wojciechowski, P. Vermeire.
Aerosolized furosemide in wheezy infants: a negative report.
Pediatr Pulmonol, 20 (1995), pp. 16-20
[127.]
M.Z. Youssef-Ahmed, P. Silver, L. Nimkoff, M. Sagy.
Continous infusion of ketamine in mechanically ventilated children with refractory bronchiolitis.
Intensive Care Med, 22 (1996), pp. 972-976
[128.]
A. Zuniga, R. Burdach, S. Rubio.
Dimethyl sulfoxide therapy in bronchiolitis.
N Y Acad Sci, 243 (1975), pp. 460-467
[129.]
A. Labbé.
Mucolytiques, antitussifs et autres medicaments.
Arch Pediatr, 8 (2001), pp. 98-99
[130.]
G.H. Guyatt, J. Sinclair, D. Cook, P. Glasziour.
Users’guides to the medical literature: XVI. How to use a treatment recommendation.
JAMA, 281 (1999), pp. 1836-1843
[131.]
P.H. Perlstein, U.R. Kotagal, P.J. Schoettker, H.D. Atherton, M.K. Farrel, W.E. Gerhardt, et al.
Sustaining the implementation of an evidence-based guideline for bronchiolitis.
Arch Pediatr Adolesc Med, 154 (2000), pp. 1001-1007
[132.]
P.H. Perlstein, U.R. Kotagal, C. Bolling, R. Steele, P.J. Schoettker, H.D. Atherton, et al.
Evaluation of an evidence-based guideline for bronchiolitis.
Pediatrics, 104 (1999), pp. 1334-1341
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