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Status asthmaticus in children: a review
1Division of Critical Care, University of Kentucky Children's Hospital, Lexington, KY 40536, USA. hwerner@pop.uky.edu
Insights
Pediatric asthma, a growing concern, involves inflammation and airway narrowing. Aggressive treatment is crucial, with mechanical ventilation reserved for severe cases and managed cautiously to avoid complications.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Pediatric asthma affects approximately 10% of American children.
- Increasing prevalence, morbidity, and mortality rates highlight the severity of childhood asthma.
- Asthma is characterized by airway inflammation, edema, bronchial constriction, and mucous plugging.
Purpose of the Study:
- To outline the aggressive treatment strategies for status asthmaticus in children.
- To discuss the risks and management of mechanical ventilation in pediatric severe asthma.
- To explore unusual and nonestablished therapies for severe asthma cases.
Main Methods:
- Review of current treatment protocols for pediatric status asthmaticus.
- Analysis of the physiological impact of positive-pressure ventilation in dynamic hyperinflation.
- Discussion of alternative and emerging therapeutic approaches.
Main Results:
- Status asthmaticus necessitates aggressive treatment with beta-agonists, anticholinergics, and corticosteroids.
- Positive-pressure ventilation can exacerbate dynamic hyperinflation in intubated children.
- Controlled hypoventilation with low tidal volume and extended expiratory time may mitigate risks like barotrauma and hypotension during mechanical ventilation.
Conclusions:
- Early and aggressive medical management is key for pediatric asthma.
- Mechanical ventilation in pediatric asthma carries significant risks and requires careful consideration.
- Further research into novel therapies for severe pediatric asthma is warranted.
Abstract:
About 10% of American children have asthma, and its prevalence, morbidity, and mortality have been increasing. Asthma is an inflammatory disease with edema, bronchial constriction, and mucous plugging. Status asthmaticus in children requires aggressive treatment with beta-agonists, anticholinergics, and corticosteroids. Intubation and mechanical ventilation should be avoided if at all possible, as the underlying dynamic hyperinflation will worsen with positive-pressure ventilation. If mechanical ventilation becomes necessary, controlled hypoventilation with low tidal volume and long expiratory time may lessen the risk of barotrauma and hypotension. Unusual and nonestablished therapies for severe asthma are discussed.