What are the history and physical (H&P) findings for a 4-month-old male admitted to the Pediatric Intensive Care Unit (PICU) with Respiratory Syncytial Virus (RSV) bronchiolitis requiring High-Flow Nasal Cannula (HFNC) therapy?

From the Guidelines

The patient is a 4-month-old male admitted to the PICU with RSV bronchiolitis requiring high-flow nasal cannula (HFNC) support, and the primary focus of his treatment plan should be on respiratory support, hydration, and close monitoring of his respiratory status and work of breathing, with potential escalation to non-invasive ventilation or intubation if clinical deterioration occurs, as recommended by the American Academy of Pediatrics 1. The patient presented with a 3-day history of progressive respiratory symptoms including cough, congestion, rhinorrhea, and increased work of breathing. He developed fever of 101.5°F and decreased oral intake over the past 24 hours. His respiratory status deteriorated with tachypnea (respiratory rate 60-70), nasal flaring, subcostal and intercostal retractions, and oxygen saturation of 88% on room air, necessitating HFNC at 8L/min with 40% FiO2.

Key Points

• Physical examination reveals a tachypneic, irritable infant with diffuse wheezing, crackles throughout lung fields, and prolonged expiratory phase.
• Nasal swab confirmed RSV infection.
• The patient was born at term with no significant past medical history and no prior hospitalizations.
• Current management includes HFNC support, IV hydration at maintenance rate, respiratory monitoring, and supportive care including nasal suctioning.
• Antipyretics are being administered for fever control.
• The patient is NPO with IV fluids while respiratory effort remains high.

Expected Course

• The expected course involves 3-5 days of supportive care with gradual weaning of respiratory support as symptoms improve.
• Close monitoring of the patient's respiratory status and work of breathing is crucial, with potential escalation to non-invasive ventilation or intubation if clinical deterioration occurs, as recommended by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1.

From the Research

History of Present Illness

• The 4-month-old male patient was admitted to the Pediatric Intensive Care Unit (PICU) with a diagnosis of RSV bronchiolitis.
• The patient is currently on high-flow nasal cannula (HFNC) therapy.
• Symptoms of RSV bronchiolitis may include rhinorrhea, congestion, sneezing, fever, cough, tachypnea, retractions, difficulty feeding, and accessory muscle use 2.
• The patient's oxygen saturation should be maintained above 90% 2.

Past Medical History

• There is no mention of any previous medical conditions that may be relevant to the current admission.
• However, it is known that RSV bronchiolitis can increase the risk of asthma later in life 2.

Treatment and Management

• The patient is currently receiving supportive care with HFNC therapy, which is a common treatment for mild to moderate bronchiolitis 3.
• Oxygen therapy and fluid management are the primary treatments for RSV bronchiolitis 2, 4.
• Other therapies such as bronchodilators, corticosteroids, and ribavirin are not recommended for routine use in bronchiolitis 5, 2, 4.
• The patient's hydration and nutrition should be maintained through nasogastric or intravenous routes if needed 2.

Physical Examination

• The patient's vital signs and physical examination findings are not provided.
• However, it is expected that the patient would have signs of respiratory distress, such as tachypnea, retractions, and accessory muscle use 2.
• The patient's oxygen saturation and respiratory status should be closely monitored while on HFNC therapy 6, 3.