Bronchiolitis acutaPříspěvek k urychlení diagnózy a racionalizaci léčby

Bronchiolitis Acuta. Contribution to a More Rapid Diagnosis and Rationalization of Treatment

At a time of increased incidence of respiratory infections children are encountered with progressing mixed dyspnoea which does not respond well to standard bronchodilatating treatment. The cause of the mentioned clinical conditions is acute bronchilitis. It affects in particular junior patients and the so-called „risk group“ of children. In the etiology of the disease virus infections predominate. Only rarely some bacterial strains can initiate immunopathogenic processes leading to the development of acute bronchiolitis.A severe course of the disease leads rapidly to general respiratory insufficiency. A typical manifestation of the disease is persisting tachypnoea, dyspnoea, hypoxaemia and hyperkalaemia with extremely increased respiratory activity. These cases call for a multidisciplinary approach and hospitalization in special intensive care units. Effective treatment includes oxygen inhalation, dehydration and sedation of the patient. In serious cases tracheal intubation and mechanical ventilation. Not in all cases odes conventional ventilation produce the desired effect. The team must be well prepared and equipped for a non-conventional therapeutic approach.The authors present an account on 17 patients with a severe course of acute bronchiolitis. Tables summarize typical clinical manifestations, changes of the milieu interieur, laboratory tests and the course of acute bronchiolitis. X-ray skiagrams show typical findings. The discussion deals with the latest findings regarding the pathogenesis of the disease. In the conclusion the tested diagnostic and therapeutic algorithm which proved useful is presented.

Key words:
bronchiolitis, conventional artificial pulmonary ventilation, inhalation of nitrogen oxide (iNO)