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Inpatient Albuterol

Bronchiolitis team recommendation: Based on moderate to low, Bronchiolitis CPG Team recommends that short acting beta agonists not be used for the inpatient treatment of the child who presents for the first time with the symptoms of bronchiolitis. We placed high value on avoiding exposure to a medication without evidence to support its use. This recommendation can apply to most patients in most circumstances. All studies identified by this CPG team were included in the Gadomski and Brower (2010) Cochrane Database of Systematic Reviews (CDSR). Gadomski and Brower (2010) reported from seven moderate quality studies that clinical score did not improve with the use of beta- agonists. From 5 moderate quality inpatient studies, use of beta agonists did not decrease length of stay and from two moderate quality studies, use of beta agonists did not affect time to resolution of illness, measured in days.

Literature supporting this recommendation: Twenty one citations were found from the literature search. One CDSR paper is included (Gadomski and Brower, 2010). Single studies identified in by the Bronchiolitis Team are included in the CDSR, and are not reported upon separately.

Critically Appraised Topic (CAT): Albuterol

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.