2 Research recommendations
The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The Guideline Development Group's full set of research recommendations is detailed in the full guideline.
What is the clinical and cost effectiveness of oxygen saturation (SpO2) measurement in primary care in children with bronchiolitis?
There are no studies to inform the use of SpO2 measurement in primary care. SpO2 is used routinely in secondary care to help decide on the need for admission to hospital. The clinical and cost effectiveness of SpO2 measurement in primary care is also important. SpO2 is not routinely measured in infants and young children with bronchiolitis in primary care. The value of SpO2 measurement to help identify those who need admission to hospital should be assessed. Possible outcomes might be fewer or more infants being referred to hospital, or admitted.
In children with bronchiolitis can paediatric early warning score (PEWS) predict deterioration?
In children with bronchiolitis there is clinical uncertainty about the prediction of deterioration. There are a number of clinical scores for bronchiolitis that include objective and subjective measures. No bronchiolitis score is currently in widespread use in clinical practice. Increasingly, PEWS are being employed generically in paediatric practice in the UK. The effectiveness of PEWS scores in predicting deterioration for infants with bronchiolitis needs to be assessed.
What is the efficacy of combined bronchodilator and corticosteroid therapy?
There are no effective therapies for the treatment of bronchiolitis. One study reported that infants provided with both nebulised adrenaline and systemic steroids had improved clinical outcomes. This was a subgroup analysis, so was not anticipated in the trial design and consequently the analysis was not adequately powered to answer this question. A multicentre randomised controlled trial (RCT) that assesses the clinical and cost effectiveness of combined adrenaline and corticosteroids treatment for bronchiolitis is needed.
What is the clinical and cost effectiveness of high‑flow humidified oxygen versus standard supplemental oxygen?
Providing oxygen (typically by nasal cannula) is standard care for bronchiolitis. Newly‑developed medical devices can now deliver high‑flow humidified oxygen that is thought to provide more comfortable and effective delivery of gases while retaining airway humidity. The use of this medical device is becoming widespread without demonstration of additional efficacy. A multicentre RCT comparing high‑flow humidified oxygen and standard supplemental oxygen would be of benefit, as would including weaning strategies for high‑flow humidified oxygen.
What is the clinical and cost effectiveness of suction to remove secretions from the upper respiratory tract compared with minimal handling?
Suction is a commonly used therapy in bronchiolitis. Infants are obligate nasal breathers, so removal of secretions is thought to relieve respiratory distress. However, suction is distressing to infants and parents. Methods vary and there is no evidence on which approach, if any, is most effective. In some trials it appears that minimal handling is more effective than therapies. A multicentre RCT comparing the clinical and cost effectiveness of suction (also covering different suction strategies, for example superficial versus deep) with minimal handling is needed.