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Updated: May 11, 2026
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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Corticosteroid therapy in critically ill pediatric asthmatic patients
John S Giuliano1, Edward Vincent S Faustino, Simon Li
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. John.giuliano@yale.edu
Summary
Pediatric intensivists often use higher IV corticosteroid doses for critically ill children with asthma than guidelines recommend. Clinical experience, not evidence, drives these dosing preferences in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Respiratory medicine
Background:
- Intravenous (IV) corticosteroids are standard for severe pediatric asthma.
- Lack of specific dosing guidelines for pediatric intensive care units (PICUs).
Purpose of the Study:
- To investigate current corticosteroid dosing practices for asthmatic children in North American PICUs.
- To identify factors influencing dosing decisions among pediatric intensivists.
Main Methods:
- Cross-sectional survey administered to pediatric intensivists in the US and Canada.
- Data collected on corticosteroid choice, dosage, and rationale.
Main Results:
- 104 intensivists responded; 96% use IV methylprednisolone.
- 66% use 4 mg/kg/d, and 31% use 2 mg/kg/d, exceeding NIH guidelines.
- 85% cite clinical experience as the primary rationale for dosage selection.
Conclusions:
- PICU practices for corticosteroid dosing in severe pediatric asthma deviate from established guidelines.
- Clinical experience is the main driver, highlighting a need for evidence-based recommendations.
- Further research is essential to establish optimal corticosteroid regimens for this population.
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