Refer Jacob to high dependency care for a trial of non-invasive ventilation and see if that avoids the need for invasive ventilation.
The main goal of treatment is to correct abnormalities in oxygenation and hydration. Therefore, treatment is supportive: appropriate supplemental oxygen is given, tube feeding is started, and gentle nasal suctioning is performed. Most other therapies have not been convincingly shown to alter the course of bronchiolitis, or to shorten the duration of hospitalisation. The National Institute for Health and Care Excellence (NICE) guidelines recommend against routine use of systemic steroids and inhaled bronchodilators in the setting of bronchiolitis. Antibiotics should not be started unless there is clear evidence of a bacterial infection.
Jacob improves on these therapies and after 7 days is discharged home.
Two years later, Jacob has recovered although has ongoing wheeze.
