What is the first-line management for a non-life-threatening RSV bronchiolitis with hypoxemia?

• A. Oxygen therapy to maintain SpO2 above 90-92% and supportive care.
• B. Immediate intubation and mechanical ventilation.
• C. Antibiotics to prevent bacterial pneumonia.
• D. Nebulized bronchodilators only.

Answer: (A)

The first priority is to correct low oxygen levels with supplemental oxygen while providing overall supportive care. In RSV bronchiolitis, the airways are inflamed and congested, so ensuring adequate oxygen delivery to avoid hypoxemia is the key initial step. If SpO2 falls below the target range, oxygen should be given to keep it around 92% or higher, using the most appropriate delivery method (e.g., nasal cannula). Alongside oxygen, supportive measures such as ensuring fluids, clearing nasal passages to improve airflow, maintaining comfortable hydration, and careful monitoring are essential as the child recovers. Intubation and mechanical ventilation are reserved for remaining or impending respiratory failure, not a non-life-threatening case. Antibiotics aren’t routinely used unless there’s suspicion of a concurrent bacterial infection, and bronchodilators aren’t guaranteed to help on their own. So, maintaining oxygenation with supportive care is the best initial management.