Acute viral bronchiolitis (AVB) is the most common infection of the lower airways in children under 2 years of age. Attempts to determine the severity of the disease based on clinical and radiological manifestations are a major challenge. Measurements of the anatomy of the trachea, main bronchi and bronchioles are not limited to pure anthropometry, but are also useful for better knowledge and applicability in pulmonary physiology, thoracic surgery, anesthesiology and in the care of critically ill patients. This is a cross-sectional, retrospective study, which included all patients admitted to a tertiary hospital in the city of Porto Alegre, over a period of one year, with a diagnosis of AVB. The interbronchial angle (ITB) of these patients was measured and clinical and epidemiological characteristics were analyzed. A total of 425 patients were included, diagnosed with BVA by respiratory syncytial virus (RSV) confirmed by immunofluorescence. Most of these patients were male (59.5%) and the median age was 130 days, 91.11% of them required oxygen therapy through a nasal catheter, 3.3% used non-invasive ventilation (NIV) and 4% mechanical ventilation (MV) . Among the studied patients, we obtained only one death (0.2%). Those who required MV or NIV and support in an intensive care unit were considered serious. The mean ITB was lower for these patients than for less severe ones. It is concluded that the ABI has a correlation with the prognosis of patients with AVB and, after further studies, can be used as a severity score.

Management of acute bronchiolitis remains controversial due to lack of strong evidence-based data. Nebulized epinephrine and hypertonic saline have been studied in infants with bronchiolitis, with conflicting results. This systematic review and meta-analysis aimed to evaluate the efficacy on length of stay (LOS), clinical severity scores (CSS), oxygen saturation (SaO2) and safety profile of nebulized epinephrine plus hypertonic saline (HS) in infants with acute bronchiolitis. Outcomes were represented by mean differences (MD) or standard mean differences (SMD) and 95% confidence intervals (CIs) were utilized. 18 trials were systematically selected and 16 of them contributed for the meta-analysis (1,756 patients). Overall, a modest but significant positive impact was observed of the combination therapy on LOS (MD of – 0.35 days, 95% CI -0.62 to -0.08, p = 0.01, I2 = 91%). Stratification by time of CSS assessment unveiled positive results in favor of the combination therapy in CSS assessed 48 hours and 72 hours after the admission (SMD of -0.35, 95% CI -0.62 to -0.09, p = 0.008, I2 = 41% and SMD of -0.27, 95% CI -0.50 to -0.04, p = 0.02, I2 = 0%, respectively). No difference in SaO2 was observed. Additional data showed a consistent safety profile, with a low rate of adverse events (1%), most of them mild and transient. In conclusion, nebulized epinephrine plus HS may be considered as a safe, cheap and efficient alternative for decreasing LOS and CSS in infants with acute bronchiolitis, especially on those who require more than 48 hours of hospitalization.

Introduction: The diagnosis of acute viral bronchiolitis (AVB) is primarily based on the findings in pulmonary auscultation. There is no consensus on which auscultatory finding is the most frequent in AVB. This study aims to describe the pulmonary auscultation in a series of patients with AVB and verify its association with age, sex, viral agent, and duration of oxygen therapy. Method: Pulmonary auscultation was recorded in patients hospitalized for AVB between October 2018 and October 2019 using an electronic stethoscope and then parallelly analyzed by two examiners. The effect of other factors such as sex, age, duration of oxygen therapy and etiological agent was analyzed for any possible associations. Results: Of 114 patients, 67 (58.8%) produced wheeze, 43 (37.7%) produced crackles, and 4 (3.5%) had normal auscultation. Wheezing was predominant in male patients while crackling in female patients (67.1% and 52.3%, respectively; p = 0.039). Age had no significant influence on the auscultation pattern (p = 0.054), etiological agent (p = 0.053) and the duration of oxygen therapy (p = 0.877). The median age was higher in patients with parainfluenza compared to those with RSV (6.5 and 4.4 months, respectively; p = 0.044). The duration of oxygen therapy was higher in patients with RSV compared to those with no identified virus (median 5.2 and 2.68 days, respectively; p = 0.018). Conclusions: Wheezing was recorded as the predominant auscultation finding among hospitalized patients with AVB. The type of virus associated with AVB had no influence on the changes in pulmonary auscultation.