Nasal Suctioning in Acute Bronchiolitis for Children Under 2 Years
Routine deep suctioning is not recommended in acute bronchiolitis for children under 2 years of age, while gentle external nasal suctioning may provide temporary relief of nasal congestion and upper airway obstruction. 1
Evidence on Nasal Suctioning in Bronchiolitis
- Deep suctioning has been associated with longer length of hospital stay in infants 2-12 months of age with bronchiolitis 1
- External nasal suctioning may provide temporary relief of nasal congestion and upper airway obstruction 1
- Lapses greater than 4 hours in noninvasive external nasal suctioning have been associated with longer hospital stays 1
- Current evidence is insufficient to make a definitive recommendation about the optimal suctioning approach, but routine deep suctioning appears not to be beneficial 1
Recent Research Findings
- A 2024 prospective observational study found no difference in respiratory scores or outpatient outcomes between different suction types (nasal aspiration vs. deep suctioning) 2
- This study showed that timepoint had an effect on respiratory score between 0 and 30 minutes post-suction and between 0 and 60 minutes post-suction, regardless of suction type 2
- The study concluded that deep suctioning may not be needed in all infants with bronchiolitis 2
Approach to Nasal Suctioning in Bronchiolitis
When to Consider Nasal Suctioning
- When there is visible nasal congestion affecting breathing or feeding 3, 4
- Before feeding to improve the infant's ability to feed 4
- When upper airway obstruction is contributing to respiratory distress 1
Recommended Suctioning Technique
- Gentle external nasal suctioning is preferred over deep suctioning 1, 2
- Nasal suctioning should be performed as needed rather than on a strict schedule 1, 2
- Consider using saline drops before suctioning to help loosen secretions 4, 5
Important Considerations and Caveats
- Bronchiolitis is a self-limiting disease in most children, with a mean duration of 8-15 days 6, 3
- The main goal of supportive care in bronchiolitis is to maintain adequate hydration and oxygenation 7, 5
- Positioning of the child (such as slightly elevating the head) may affect respiratory assessment and can be used as an additional supportive measure 1, 3
- Children with risk factors (prematurity, congenital heart disease, chronic lung disease, neuromuscular disease, or immunodeficiency) may require more careful assessment and management 6, 5
Pitfalls to Avoid
- Overreliance on deep suctioning, which may prolong hospital stays 1, 2
- Excessive suctioning that may cause trauma to the nasal mucosa or increased distress 4
- Neglecting to suction when needed, as lapses greater than 4 hours in external nasal suctioning have been associated with longer hospital stays 1
- Focusing solely on suctioning while neglecting other important supportive measures such as hydration and oxygen support when needed 7, 5