Futilidad clínica, inercia terapéutica y estrategias de desimplementación de beta-2 agonistas en la bronquiolitis aguda: Una revisión integrativa

Denise Muñoz; Shirley Michelle Huang Liao; Ruth Leiva; Marcos Monges; Pamela Mercedes Cousirat Guillén

doi:10.66201/ss.v1.4

Authors

Denise Muñoz Hospital General de Itapúa, Encarnación, Paraguay Author https://orcid.org/0009-0003-7551-2211
Shirley Michelle Huang Liao Hospital General de Itapúa, Encarnación, Paraguay Author https://orcid.org/0009-0006-9021-6711
Ruth Leiva Hospital General de Itapúa, Encarnación, Paraguay Author https://orcid.org/0009-0001-4106-4284
Marcos Monges Hospital General de Itapúa, Encarnación, Paraguay Author https://orcid.org/0009-0006-3024-5094
Pamela Mercedes Cousirat Guillén Universidad Católica «Nuestra Señora de Asunción», Asunción, Paraguay Author https://orcid.org/0009-0002-1444-0982

DOI:

https://doi.org/10.66201/ss.v1.4

Keywords:

Bronchiolitis, Beta-Agonists, Therapeutic Futility, Therapeutic Inertia, De-Implementation, Salbutamol, Respiratory Syncytial Virus

Abstract

Introduction: Acute bronchiolitis is the leading cause of hospital admission in infants. Despite evidence of its futility, the routine use of beta-2 agonists (salbutamol) persists, a low-value practice that leads to therapeutic inertia. The aim of this integrative review was to synthesize the evidence on the ineffectiveness and risks of these agents and to systematize effective strategies for their discontinuation.

Methods: An integrative review design (Whittemore and Knafl framework) was applied, with reporting adhering to PRISMA 2020. The systematic search (2014–2024) focused on literature published after the 2014 AAP guideline. Methodological quality was assessed using the MMAT tool, and data were narratively synthesized into four domains: clinical futility, safety, therapeutic inertia, and de-implementation strategies.

Results: Clinical futility was consistently confirmed: salbutamol does not reduce hospital stay (MD: 0.12 days) or improve oxygen saturation. This ineffectiveness is attributed to the downregulation of beta-2 receptors induced by respiratory syncytial virus (RSV) infection. Safety risks include tachycardia, tremors, and transient hypoxemia due to ventilation-perfusion mismatch (V/Q mismatch). Inertia is more prevalent in primary care, driven by physician “action bias” and the pressure of parental expectations (technological placebo).

Conclusion: Treatment failure is structural, and its continued use violates the principle of non-maleficence, also entailing an opportunity cost. Successful discontinuation requires active behavioral strategies: “replacing the action” with visible support (nasal suction, parent education), modifying the decision-making environment (CDSS), and using comparative audit and feedback. Clinical excellence lies in providing strict physiological support.

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