The Nihilistic AAP Bronchiolitis Guidelines

​Not only has the COVID-19 pandemic killed millions of people, but it has also caused disruptions in every imaginable aspect of our lives. One has been the seasonality of other diseases like influenza and respiratory syncytial virus infection. RSV infection is typically a winter disease, but here we are in the summer months and our pediatric emergency department is flooded with infants infected with RSV.I expressed concern about the 2014 American Academy of Pediatrics bronchiolitis guidelines three years ago. (EMN. 2019;41[1]:31; http://bit.ly/2TlwNj9.) Those comments have proven to have real-life clinical relevance, now more than ever. It is not possible to review all of the current evidence-based research, but watch the video for references to some of the new evidence.These problematic AAP guidelines boldly recommended that we cease and desist with the mainstays of treatment, leaving physicians with essentially nothing but nasal suctioning. (Pediatrics. 2014;134[5]:e1474.) Here are verbatim excerpts:Clinicians should NOT administer albuterol (or salbutamol) to infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).Clinicians should NOT administer epinephrine to infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommendation Strength: Strong Recommendation).Nebulized hypertonic saline should NOT be administered to infants with a diagnosis of bro...
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