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Pulsus paradoxus in asthmatic children
Insights
Pulsus paradoxus, a drop in systolic blood pressure during inspiration, indicates severe asthma attacks in children. This physical sign reliably correlates with airway obstruction severity in pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Pulsus paradoxus is an established indicator of asthma severity in adults.
- Its utility in assessing asthma severity in pediatric patients remains less defined.
Purpose of the Study:
- To determine if pulsus paradoxus is a reliable indicator of asthma severity in children.
- To correlate pulsus paradoxus measurements with objective measures of airway obstruction.
Main Methods:
- Respiratory fluctuations in systolic blood pressure were measured in 24 children during asthma attacks.
- 1-second forced expiratory volume (FEV1) was used to quantify airway obstruction.
- Systolic pressure fluctuations were compared between asthmatic and non-asthmatic children.
Main Results:
- A pulsus paradoxus exceeding 15 mm Hg was observed only when FEV1 was less than 60% of predicted.
- A highly significant correlation (P < 0.001) was found between pulsus paradoxus magnitude and airway obstruction severity.
- Non-asthmatic children exhibited minimal systolic pressure fluctuations (≤7 mm Hg) during respiration.
Conclusions:
- Pulsus paradoxus (≥15 mm Hg) is a valuable clinical sign for identifying severe asthma exacerbations in children.
- This finding is consistent with its established role in adult asthma assessment.
- The measurement provides a non-invasive method to gauge the critical nature of pediatric asthma attacks.
Abstract:
Pulsus paradoxus is a useful physical sign in the assessment of the severity of asthma in adults. Whether this is also true for asthmatic children was determined by measuring respiratory fluctuations in systolic blood pressure during attacks of asthma in 24 children. A decrease in systolic pressure during inspiration exceeding 15 mm Hg was found only when the 1-second forced expiratory volume was less tha 60 percent of the predicted value. There was a highly significant (P smaller than 0.001) correlation between the degree of pulsus paradoxus and the severity of airway obstruction. In nonasthmatic children the systolic pressure was found to fluctuate by as much as 7 mm Hg during the respiratory cycle. It is concluded that, as in adults, the presence of pulsus paradoxus (larger than or equal to 15 mm Hg) in children indicates that their asthma is very severe.