Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

With RSV, it’s time for primary care to step up to the plate

Martin C. Young, MD
Conditions
December 7, 2022
Share
Tweet
Share

Every pediatrician is familiar with this endemic seasonal virus, expecting to see several cases in their office during the winter months and maybe even admit the occasional one for inpatient care. Even amongst the latter, most do well and recover without incident, though the stay can be prolonged.

However, the respiratory syncytial virus — when it causes pneumonia and bronchiolitis (inflammation of the small airways — can result in serious illness and even fatality, especially in infants, ex-premature babies, and young children with comorbidities.

The U.S. is presently experiencing an unusual epidemic of RSV in terms of timing and severity that is filling pediatric hospital beds with bronchiolitis patients. This is at a time when the number of pediatric beds is falling as smaller hospitals have closed their non-profitable pediatric units.

Many children’s hospitals are near capacity, and some have closed to non-urgent surgery to free up beds. Emergency departments are being flooded. In some hospitals, patients are being boarded in the ED.

The epidemic is but part of a current “triple epidemic” of respiratory diseases: COVID, influenza, and RSV. There is no vaccine, although the flu shot does provide some protection. Hospitals need to prepare for a possible extreme onslaught of children with respiratory illnesses.

The older infant with mild bronchiolitis can often be cared for by her primary care pediatrician in a standard pediatric ward or unit. Care is largely supportive, maintaining hydration with intravenous fluids and oxygenation with a nasal cannula or headbox oxygen as the illness slowly resolves. Though the infants are intensely wheezy, traditional bronchodilators rarely provide relief, and steroids don’t help. There are few acute diseases that make both pediatricians and parents feel so helpless.

Some children require a higher level of care. An intermediate care unit (IMCU) rather than the PICU is adequate for most of these. IMCUs provide bronchiolitis care where more sophisticated means of oxygenation are required — for example, non-invasive positive pressure ventilation (CPAP, BIPAP) or high-flow humidified oxygen, but not full ventilation.

In May 2022, the American Academy of Pediatrics updated its recommendation on these units in the journal Pediatrics.

Unfortunately, IMCUs are rare outside hospitals that have PICUs, where they often serve as step-up/step-down units. Smaller hospitals would have trouble establishing such units due to cost and a deficiency of expertise. Sophisticated respiratory support requires equipment along with appropriately trained nurses and respiratory therapists, and few primary care pediatricians have the necessary skill set, meaning that hospitalists would need to be employed.

Hospitals that still maintain pediatric beds are often reluctant to care for infants with even mild bronchiolitis. In my experience, the degree of respiratory distress observed is alarming to nursing staff and respiratory therapists, who may press for transfer to a higher level of care, even though oxygenation and hydration are being well maintained. Everyone just feels uncomfortable and helpless.

Parents will often push for transfer; they observe that “nothing is being done.” That is: no antibiotics, medications, or nebulizer therapy if their pediatrician is following current guidelines. They believe that bigger or children’s hospitals will have more to offer when, in fact, step-up care is not needed. This puts a further load on these centers, which are now flooded with patients that could safely be cared for locally.

Nevertheless, general hospitals with small pediatric units need to prepare themselves to care for bronchiolitis sufferers whom they might more usually transfer out.

Pediatricians on staff at the hospital should meet with respiratory therapists and decide on a standard protocol for managing these cases. They would do well to adopt the Children’s Hospital of Philadelphia (CHOP) inpatient clinical pathway for bronchiolitis, available online. These hospitals might consider upping their level of respiratory support by acquiring devices that deliver heated, humidified high-flow oxygen therapy, such as the one manufactured by Vapotherm. These are not difficult to use and can reduce the work of breathing and improve oxygenation in some cases.

ADVERTISEMENT

All in all, it promises to be a miserable winter season for pediatrics with an emphasis on respiratory illness. Community primary care pediatricians need to step up to the plate.

Martin C. Young is a pediatric endocrinologist.

Prev

How women manage and mismanage their health [PODCAST]

December 6, 2022 Kevin 0
…
Next

If the hospital CEO emailed employees like Twitter's CEO

December 7, 2022 Kevin 3
…

Tagged as: Pediatrics, Pulmonology

Post navigation

< Previous Post
How women manage and mismanage their health [PODCAST]
Next Post >
If the hospital CEO emailed employees like Twitter's CEO

ADVERTISEMENT

More by Martin C. Young, MD

  • Is there a place for audiovisual recording in medicine?

    Martin C. Young, MD
  • My battle with atrial fibrillation

    Martin C. Young, MD
  • A surprising acne rosacea remedy

    Martin C. Young, MD

Related Posts

  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD
  • The many benefits of strengthening the primary care workforce

    Nicole Liner-Jigamian, MSW
  • Primary care faces a very difficult winter

    Ken Terry
  • The biggest health care fix: a relentless focus on primary care

    Suneel Dhand, MD
  • The hidden work of primary care

    Michelle Nall, MPH, ANP-BC
  • How the CPT system shortchanges primary care

    Richard Young, MD

More in Conditions

  • What Elon Musk and Diddy reveal about the price of power

    Osmund Agbo, MD
  • Understanding depression beyond biology: the power of therapy and meaning

    Maire Daugharty, MD
  • Why medicine must stop worshipping burnout and start valuing humanity

    Sarah White, APRN
  • Why perinatal mental health is the top cause of maternal death in the U.S.

    Sheila Noon
  • A world without vaccines: What history teaches us about public health

    Drew Remignanti, MD, MPH
  • Unraveling the mystery behind one of the most dangerous pregnancy complications: preeclampsia

    Thomas McElrath, MD, PhD and Kara Rood, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Who will train the next generation of primary care clinicians without physician mentorship? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • The CDC’s restructuring: Where is the voice of health care in the room?

      Tarek Khrisat, MD | Policy
    • Choosing between care and country: a dual citizen’s Independence Day reflection

      Kathleen Muldoon, PhD | Policy
    • What Elon Musk and Diddy reveal about the price of power

      Osmund Agbo, MD | Conditions
    • 3 tips for using AI medical scribes to save time charting

      Erica Dorn, FNP | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Who will train the next generation of primary care clinicians without physician mentorship? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • The CDC’s restructuring: Where is the voice of health care in the room?

      Tarek Khrisat, MD | Policy
    • Choosing between care and country: a dual citizen’s Independence Day reflection

      Kathleen Muldoon, PhD | Policy
    • What Elon Musk and Diddy reveal about the price of power

      Osmund Agbo, MD | Conditions
    • 3 tips for using AI medical scribes to save time charting

      Erica Dorn, FNP | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

With RSV, it’s time for primary care to step up to the plate
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...