Hawks vs Doves: A Debate on Common Controversies in the Management of Acute Respiratory Illnesses in Hospitalized Children

Saturday, April 26, 2025

7:00am – 8:30am HST

Location: Convention Center: 313 C

CE: 1.5

Selected By: PHM
Co-sponsored By: PIDS

Chair(s)

Alan Schroeder, MD

Clinical Professor of Pediatrics
Stanford university school of medicine
Palo Alto, California, United States

Disclosure(s):

Alan Schroeder, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Respiratory illnesses are leading drivers of hospitalization and ED visits in children. For many of these conditions, there is ongoing debate over the evidence-base and the appropriateness of common interventions. The overuse of unnecessary interventions can drive excessive costs and patient harm, while underuse of beneficial interventions can lead to suboptimal patient outcomes.

This pro/con debate session will feature experts representing Pediatric Hospital Medicine, Pediatric Critical Care, Pediatric Infectious Disease, and Pediatric Emergency Medicine, and will focus on three timely controversies surrounding the management of children with acute respiratory illnesses. First, for children with respiratory distress, the use of high-flow nasal canula (HFNC) has increased astronomically over the last decade, with associated increases in ICU admissions and hospital LOS. Although some trials suggest benefit of HFNC in various circumstances, these trials were generally unblinded and allowed for crossover, making their interpretation challenging. Second, for bronchiolitis, guidelines recommend against routine use of pharmacotherapies, yet bronchodilators and other treatments continue to be used frequently – even more so following the pandemic. Third, for children hospitalized with influenza, although national guidelines suggest routine treatment with antivirals, there is limited evidence to support these recommendations, and adherence is low.

This educational, entertaining, and provocative debate will feature a Q&A following each debate topic. Speaker assignment to the “hawk” vs “dove” side was determined by a coin flip. The debate winners will be decided by vote movement from audience polling before and after each session.

Learning Objectives:

Review key trials on HFNC in children with bronchiolitis and other conditions and understand their limitations.
Understand the basis for professional society recommendations against bronchodilators in bronchiolitis and appreciate the arguments supporting a trial of bronchodilators in some patients.
Review professional guidelines on antiviral use in children hospitalized with influenza and analyze recent studies that have supported the need for a randomized trial

Presentations:

7:00am – 7:05am HST

Introduction/setting the Debate Stage
Speaker: Alan Schroeder, MD – Stanford university school of medicine
7:05am – 7:15am HST

High-flow Nasal Canula (HFNC) for Respiratory Support: HFNC Should Be Given to All Children with Respiratory Distress (Hawk)
Speaker: Matthew D. Garber, MD (he/him/his) – UF COM-Jacksonville
7:15am – 7:30am HST

HFNC for Respiratory Support: HFNC Is Woefully Overused (Dove)
Speaker: Chisom Agbim, MD, MSHS (she/her/hers) – Stanford
7:30am – 7:45am HST

Treatment of Bronchiolitis: Albuterol Does Work in Bronchiolitis…we Just Need to Find the Right Patients (Hawk)
Speaker: Amy Tyler, MD (she/her/hers) – Nationwide Children's Hospital
7:45am – 8:00am HST

Treatment of Bronchiolitis: When Will We Finally Agree That Nothing Works? (Dove)
Speaker: Ricardo Quinonez, MD (he/him/his) – Baylor College of Medicine
8:00am – 8:15am HST

Antivirals for Children Hospitalized with Influenza: All Hospitalized Children Should Get Treated (Hawk)
Speaker: Suchitra Rao, MBBS, MSCS (she/her/hers) – University of Colorado School of Medicine
8:15am – 8:30am HST

Anitvirals for Children Hospitalized with Influenza: Oseltamivir (guidelines) Make(s) Me Nauseous (Dove)
Speaker: Hannah K. Bassett, MD – Stanford University School of Medicine