Deffler Jared
Jared Deffler is a nurse practitioner in the cardiac intensive care unit at the Children's Hospital of Philadelphia, Pennsylvania.
Crit Care Nurse. 2025 Aug 1;45(4):29-37. doi: 10.4037/ccn2025696.
Bronchiolitis obliterans/bronchiolitis obliterans syndrome is an irreversible, obstructive lung disease characterized by the narrowing of bronchioles by lung fibrosis, inflammation, and scarring.
To provide acute care, transplant, and critical care nurses a summary of the disease process, causes, and treatment options for bronchiolitis obliterans in pediatric patients to promote early recognition of signs in at-risk patients.
This descriptive literature review was limited to articles published in 2013 or later. Searches of the PubMed and CINAHL databases using the terms bronchiolitis obliterans and pediatric yielded 432 articles. Of these articles, 22 were used for this review. The Johns Hopkins Nursing Evidence-Based Practice appraisal tool was used to assess levels of evidence and methodologic quality of the articles.
Patients in 3 main groups are at risk for bronchiolitis obliterans: those who have had respiratory infection, those who have received lung transplant, and those who have received stem cell transplant.
A diagnosis of bronchiolitis obliterans requires lung biopsy and histopathology. For patients who are unable to undergo biopsy or whose biopsy results are inconclusive, bronchiolitis obliterans syndrome can be clinically identified with spirometry (forced expiratory volume in first second of expiration and forced expiratory flow at 25% to 75% of forced vital capacity) and high-resolution computed tomography. Systemic corticosteroids are often the first-line treatment; second-line strategies are under investigation.
Knowledge of risk factors, signs, and current treatments for bronchiolitis obliterans/bronchiolitis obliterans syndrome can help acute care and critical care nurses decelerate progression of the disease.
闭塞性细支气管炎/闭塞性细支气管炎综合征是一种不可逆的阻塞性肺病，其特征为细支气管因肺纤维化、炎症和瘢痕形成而变窄。
为急症护理、移植和重症护理护士总结小儿闭塞性细支气管炎的疾病过程、病因及治疗选择，以促进对高危患者体征的早期识别。
本描述性文献综述仅限于2013年或之后发表的文章。使用“闭塞性细支气管炎”和“儿科”等术语在PubMed和CINAHL数据库中进行检索，共得到432篇文章。其中22篇用于本综述。使用约翰霍普金斯循证护理实践评估工具来评估文章的证据水平和方法学质量。
闭塞性细支气管炎的高危患者主要有3类：曾患呼吸道感染的患者、接受过肺移植的患者以及接受过干细胞移植的患者。
闭塞性细支气管炎的诊断需要进行肺活检和组织病理学检查。对于无法进行活检或活检结果不确定的患者，可通过肺活量测定法（第一秒用力呼气量和用力肺活量25%至75%时的用力呼气流量）和高分辨率计算机断层扫描在临床上识别闭塞性细支气管炎综合征。全身用皮质类固醇通常是一线治疗方法；二线治疗策略正在研究中。
了解闭塞性细支气管炎/闭塞性细支气管炎综合征的危险因素、体征和当前治疗方法，有助于急症护理和重症护理护士减缓该疾病的进展。
