Bronchiolitis Clinical Pathway – Inpatient – Respiratory Assessment

Bronchiolitis Clinical Pathway – Inpatient

Baseline Respiratory Assessment

The highest rating in any of the categories below determines the child's starting position on the pathway. A severe rating in any category indicates a starting position in the Severe classification. All Moderate assessments, or a mix of Mild and Moderate would indicate a starting position in the Moderate classification. When in doubt, err on the side of classifying a child as more severe.

    Mild (0) Moderate (1) Severe (2)
RR < 3 mos 30-60 61-80 > 80
3 - < 12 mos 25-50 51-70 > 70
1 yr - 2 yrs 20-40 41-60 > 60
WOB None or mild Intercostal retractions Nasal flaring, grunting, head bobbing
Mental Status Baseline Fussy or anxious Lethargic or inconsolable
Oxygen Requirement None < 1.5 L > 1.5 L
Suctioning Bulb Wall/Bulb Wall
Breath Sounds Clear Crackles, Wheezing Diminished breath sounds or significant crackles, wheezing
Cough Absent or mild Moderate Severe

Ongoing Respiratory Assessments

Severe Moderate Mild
Assess patient hourly Assess child every 2 hrs Assess child every 4 hrs
When 5 consecutive assessments over 4 hrs are in the Moderate range, advance to the Moderate Pathway When 3 consecutive assessments over 4 hrs are in the Mild range, advance to the Mild Pathway and begin discharge planning If symptoms do not increase after 4 hrs, discharge