A 9-month-old infant presents in winter with 3 days of rhinorrhea followed by progressive wheeze, tachypnea (70/min), severe subcostal retractions, and oxygen saturation of 88% on room air. He requires 40% FiO2 via high-flow nasal cannula. Nasopharyngeal swab is positive for RSV. Based on evidence from MIST and SIGN trials, which pharmacological intervention has shown benefit in RSV bronchiolitis?
- A High-flow heated humidified nasal cannula oxygen (HFNC) for work of breathing reduction ✓
- B Nebulized salbutamol (albuterol) to reverse airway smooth muscle spasm
- C Nebulized epinephrine + systemic dexamethasone combination (MIST trial result)
- D Systemic corticosteroids (prednisolone) to reduce mucosal inflammation
Explanation
No pharmacological intervention has been proven beneficial in RSV bronchiolitis: bronchodilators (salbutamol, epinephrine) do not improve clinical outcomes and are not recommended by AAP/NICE. The MIST trial (2009) showed nebulized epinephrine + oral dexamethasone combination had no benefit over placebo for bronchiolitis outcomes at 7 days. Systemic corticosteroids also lack proven benefit. High-flow heated humidified nasal cannula (HFNC) oxygen therapy is currently the most evidence-supported respiratory support intervention for moderate-severe bronchiolitis, reducing work of breathing, improving oxygenation, and decreasing need for CPAP/intubation compared to standard oxygen. Treatment remains supportive: hydration, supplemental oxygen, HFNC.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.