Related Experiment Video
Updated: Mar 8, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Management of Hospitalized Asthmatic Children Before Transport
Brande Mazzeo1, Rami Bzeih1, Robert Schultz1
1Wayne State University, Detroit, MI.
Insights
Pediatric asthma patients received standard ED care, but heliox was more frequently initiated by transport teams. Intubated children often received volume control ventilation in the ED.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Care
- Critical Care Transport
Background:
- Asthmatic children face significant risks of respiratory failure, necessitating prompt and effective treatment.
- Adherence to established guidelines, such as the Pediatric Advanced Life Support (PALS) guidelines, is crucial for optimal patient outcomes.
- Evaluating treatment protocols during emergency department (ED) care, inter-facility transport, and intensive care unit (ICU) management is essential for identifying areas of improvement.
Purpose of the Study:
- To assess adherence to PALS asthma treatment guidelines in the ED.
- To identify if additional treatments were required during transport or early ICU admission.
- To compare the management strategies for intubated asthmatic children across ED, transport, and ICU settings.
Main Methods:
- Retrospective review of medical records for children with acute asthma transported by an intensive care transport team over a 7-year period.
- Data collection included the administration of albuterol, steroids, oxygen, heliox, and positive airway pressure modalities.
- Analysis of ventilator settings and modes for mechanically ventilated patients.
Main Results:
- Eighty percent of 279 pediatric asthma patients received oxygen, albuterol, and steroids in the ED.
- Heliox administration was significantly more common by the transport team (77%) compared to the ED (7.7%) or ICU (15.3%) (P < .0001).
- Mechanically ventilated children were more likely to be managed with volume control (P < .0001) and higher respiratory rates (P = .007) in the ED than in the ICU.
Conclusions:
- Most pediatric patients with acute asthma receive appropriate initial treatment with oxygen, albuterol, and steroids in the ED.
- Heliox therapy, when utilized, is predominantly initiated during critical care transport.
- Mechanical ventilation strategies, specifically volume control and higher rates, are more frequently employed in the ED for intubated asthmatic children compared to the ICU.
Abstract:
Asthmatic children are at risk for respiratory failure and should be appropriately treated before transport. The objectives were to find out if the Pediatric Advanced Life Support guidelines for asthma treatment were followed in the emergency department (ED); to determine if additional treatment during transport or within the first 2 hours of admission was needed; and to compare the management of intubated asthmatics by the ED, transport team, and the intensive care unit (ICU) physician. The records for children diagnosed with acute asthma over 7 years who were transported by the intensive care transport team were reviewed. The use of albuterol, steroids, oxygen, heliox, continuous positive airway pressure or bilevel positive airway pressure, and ventilator settings was recorded. Two hundred seventy-nine children were 7 years (age, 5 mo-17 y), and 62% were male. Eighty percent received oxygen, albuterol, and steroids in the ED. Heliox was initiated more often by the transport team when compared with the ED or hospital physician (77% vs. 7.7% vs. 15.3%, P < .0001). Forty-five were mechanically ventilated and were more likely to receive volume control (P < .0001) and higher rates (P = .007) in the ED than the ICU. We conclude that most children with acute asthma were treated with oxygen, albuterol, and steroids in the ED. If used, heliox was most likely started during transport. Intubated children were more likely to receive volume control with higher rates compared with lower rates and pressure control in the ICU.
More Related Videos
Related Concept Videos
01:30Asthma-IV: Nursing Management
First, in...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:29Asthma-I: Introduction
01:23Inhaled Medications
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce...
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.