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Severe ventilatory failure in asthma in children. Experience of 13 episodes over 6 years
Insights
Severe ventilatory failure in pediatric asthma is rare, affecting about 1% of hospital admissions. Early intervention for wheezing, often triggered by viral infections, is crucial for survival, with mechanical ventilation proving effective.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Epidemiology of Respiratory Diseases
Background:
- Asthma is a common chronic respiratory disease in children.
- Severe exacerbations can lead to respiratory failure, requiring intensive care.
- Understanding risk factors and outcomes is vital for effective management.
Observation:
- A 6-year study (1971-1977) analyzed 1225 pediatric asthma admissions.
- 13 patients (1%) developed severe ventilatory failure (peak arterial PCO2 > 8 kPa).
- Mean age was 4.1 years; frequent prior admissions (5/year) and allergies were common.
Findings:
- Viral upper respiratory tract infections frequently precipitated wheezing.
- In 7 patients, wheeziness lasted 12 hours or less before hospital admission.
- Six patients (0.5%) required mechanical ventilation, all surviving.
Implications:
- Severe ventilatory failure in pediatric asthma is uncommon but serious.
- Prompt recognition and management, including mechanical ventilation, improve survival rates.
- Further research into predictive factors and evolving management strategies is warranted.
Abstract:
During the 6-year period from 1 October 1971 to 30 September 1977, 13 (about 1%) of 1225 admissions to hospital with asthma developed severe ventilatory failure (peak arterial PCO 2 greater than 8 kPa). Mean age was 4.1 years (2.3--7.9), and on average each patient had been admitted to hospital on 5 occasions during the preceding year. 11 gave a family history of asthma or a personal history of associated allergies. A viral upper respiratory tract infection was the commonest precipitant of wheeze, and in 7 patients the duration of wheeziness before admission to hospital was 12 hours or less. Six (0.5%) patients were treated by mechanical ventilation and all survived. The changing patterns of management during the study period are reviewed.