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Adjunct Therapies for Refractory Status Asthmaticus in Children
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina. kyle.rehder@duke.edu.
Respiratory Care
|May 27, 2017
Summary
This review examines adjunct therapies for severe asthma exacerbations in children when initial treatments fail. It provides evidence for treatments like magnesium and ketamine to manage refractory status asthmaticus.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Critical Care
Background:
- Asthma exacerbations frequently lead to emergency department visits in children.
- Refractory asthma flares can necessitate hospital admission and intensive care unit (ICU) stays.
- Standard initial therapies include inhaled beta-agonists and systemic corticosteroids.
Purpose of the Study:
- To review the evidence supporting various adjunct therapies for pediatric status asthmaticus.
- To present the physiologic basis for these treatments.
- To offer a care map for escalating therapy in severe cases.
Main Methods:
- Literature review of adjunct therapies for status asthmaticus.
- Summarization of supporting data and physiologic rationale.
- Development of a suggested care escalation map.
Main Results:
- Evidence for adjunct therapies such as ipratropium, magnesium, heliox, ketamine, and noninvasive ventilation varies.
- Data supporting intravenous beta-agonists, methylxanthines, antibiotics, inhaled anesthetics, and ECMO is often limited or conflicting.
- A structured approach to escalating care is proposed.
Conclusions:
- Adjunct therapies for pediatric status asthmaticus lack robust supporting data in many cases.
- A systematic approach is needed to guide the use of these therapies.
- Further research is required to clarify the efficacy of various adjunct treatments.
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