Hello!
Could somebody tell me about their experiences with RSV babies/children at their hospitals? I want to know in specific to nebulizers/CPT/NTS protocol if your workplace follows any--including dosages and preferred drugs of choice.

Also, do you have any idea on the latest for RSV treatment?
My hospital orders neb q1-q2 with low dosages of ventolin and atrovent (e.g. 1.0 mg, 1.5 mg ventolint and atrovent 62.5 mg q4)----People here are really focused on the child's weight and they are afraid of using 2.5 mg.

Can you give me any ideas/ input on the latest?
Would appreciate it very much

Go to
http://www.seattlechildrens.org/health_care_professionals/pdf/consult/consult_0501.pdf

(or type in <John Sayler RSV> into a Google search)

John has spoken alot on this topic at conferences. Basically Albuterol tx's are out of control and given way in excess, PD&P is assinine, and NT suction is way under-utilized.

(my spin above)

John has spoken and researched this topic alot.

I would try to contact him at Seattle Children's for help.

email me at whitnack@pacbell.net and I'll reply with his email (don't want to post it online without his permission as Sharon Stone may be monitoring).

With respect to your question regarding treatment of RSV.
RSV should be treated on a case by case bases. We feel that Beta 2 therapy is essentially of no use especially if patient does not respond with-in two treatments. Keep in mind that it mainly effects those children (Infants/Neonates) who are obligate nose breathers (Obviously RSV is not limited to that population). They end up as an inpatient usually because of dehydration secondary to poor PO intake. Although many of our staff still persist in Beta 2 therapy, we find that an aggressive nasal protocol (Nasal Steroid, Neosynephrine and Normal Saline and regular suction as needed) works best. Therefore, treating with Nasal protocol and Maint. IVF's for a couple of days is usually all that is required. Currently, There is a study on the use of systemic steroid use in RSV. Some physicians are begining to use this method to halt the inflamatory response which is supposed to decrease the amount of damage caused to the airway which in turn will decrease further "airway" problems in the future.

With regard to your question on dosage. Beta 2 therapy is extremely safe (with very few exceptions). The dosage that is being used at your facility would be considered extremely low. Keep in mind that with aerosol therapy patients dose themselves. Each patient has a specific TV. They will only inhale a small part of the dose given. Also, pediatric patients are generally not cooperative and you hope they get half the medication anyway (Aerosol particles may impact in upper airway more often). Some physicians elect to use Iprotropium Bromide. This medication should be reserved for the "COPD" population. It has been our experience that Iprotropium Bromide will actually exacerbate the issue by possibly causing mucus plugs secondary to "thickening of secreations". We never use this medication. It has only been proven effective in ER pediatric population.
I hope this helps your situation.[EMAIL]

Gregg M. Campbell, RRT
Respiratory Clinical Specialist
Children's Hospital
New Orleans, LA 70118
Gcampbe2@chnola.org[/EMAIL]

New practice guidelines can be found at http://www.guideline.gov/summary/summary.aspx?doc_id=9528&nbr=5078