Bronchiolitis
Indication for intubation is based on clinical features rather than blood gas results.
Differential diagnosis
Bronchiolitis is so common over the winter months it can be easy to forget that there are other diagnostic possibilities in infants presenting with respiratory failure.
Differential diagnosis includes immunodeficiency (FTT, diarrhoea, lymphopaenia), cystic fibrosis (FTT, diarrhoea), pertussis (marked lymphocytosis) and TAPVC (left sided heart failure) or other congenital heart disease (murmur, refractory hypoxia).
Remember to look for evidence of failure to thrive, history of diarrhoea and evidence of heart failre.
Antibiotics are only if indicated by positive cultures or sepsis syndrome.
NPA and NBL for all ventilated patients - samples sent for bacteriology, virology
NBL to look for Pneumocystis should be requested if there is a suspicion of immunodeficiency (e.g. lymphopaenia)
If the presentation was with apnoea, and RSV bronchiolitis is not confirmed, an LP should be performed (in the absence of contraindications)
Feed enterally as soon as possible