Randomized Controlled Trial Comparing Standard Versus Positive Pressure Nebulization in Infants With Bronchiolitis to Reduce Hospital Admissions

Hypothesis: That administration of nebulized therapy for bronchiolitis when using positive
airway pressure is superior to standard mask ventilation in reducing hospital admissions.

Bronchiolitis is a lower respiratory tract infection (LRTI) syndrome caused by a variety of
different viruses. It is the most common LRTI in children under 24 months old. Multiple
studies have documented variation in treatment, hospitalization rates, and length of
hospital stay for bronchiolitis, suggesting a lack of consensus and an opportunity to
improve care for this common disorder.

Research to determine optimal delivery methods of respiratory medications that may augment
oxygenation by decreasing atelectasis (Lung cell collapse) and increasing oxygen saturation
have not been done. Currently bronchodilators are delivered through a passive process,
inhaled as they are nebulized (made from liquid into gas) into a face mask. This study will
evaluate whether using a newly developed positive pressure nebulization device that uses
pressure to expand lung cells and, hypothetically, deliver the medication better, improves
oxygenation by reducing atelectasis (lung cell collapse) to decrease hospitalization in
infants with moderate to severe bronchiolitis.

Positive pressure nebulization is a relatively new adaptation of a previously existing
modality, and is already currently in use here at PCH.