American Academy of Pediatrics 2014 Bronchiolitis Guidelines: Bonfire of the Evidence

A BONFIRE OF THE EVIDENCE The American Academy of Pediatrics (AAP) 2014 Bronchiolitis guidelines (the guidelines) were recently published in the official journal of the AAP, Pediatrics.1 The committee that wrote the guidelines anticipates that these will form the basis of bronchiolitis treatment throughout the house of medicine, not just in pediatricians’ offices. Emergency physicians may well encounter pressure to follow these guidelines from their pediatric colleagues who, not unreasonably, rely on guidelines from their professional organization. However, two key recommendations in these guidelines could substantially change pediatric emergency medicine practice. These recommendations are (1) to not use even a trial of bronchodilators and (2) to regard oxygen saturations of 90% rather than 92%-94% as the degree of hypoxia at which oxygen should be administered.1 Neither of these recommendations is sufficiently justified by the evidence and both are potentially harmful. We deal first with the new guideline to not use bronchodilators. The committee bases its recommendation to not attempt even a trial of bronchodilators on the following: