Información del artículo
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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