Status Asthmaticus

Definitions

Pathophysiology

Figure 1: Airway Changes with Asthma

Clinical Presentation

Treatment

NHLBI Guidelines of Acute Exacerabation

Fatal and Near-Fatal Asthma in Children: The Critical Care Perspective (Newth C et al)

Intubation/Mechanical Ventilation

Figure 2: Peak to Plateau Pressure and Airway Resistance

Figure 3: Air trapping as seen on Flow vs. Time curve (Expiratory flow does not get back to baseline)


Figure 4: EtCO2 tracing in the setting of worsening airway obstruction 

References

1) M. Yung, M. South: Randomised controlled trial of aminophylline for severe acute asthma. Arch Dis Child.79:405-410 1998

2) M.O. Turner, K. Noertjojo, S. Vedal, et al.: Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma. Am J Respir Crit Care Med.157:1804-1809 1998

3) R.C. Strunk, D.A. Mrazek, G.S. Fuhrmann, et al.:Physiologic and psychological characteristics associated with deaths due to asthma in childhood. A case-controlled study. JAMA. 254:1193-1198 1985

4) B.D. Levy, B. Kitch, C.H. Fanta: Medical and ventilatory management of status asthmaticus. Intensive Care Med.24:105-117 1998

5) A.J. Buda, M.R. Pinsky, N.B. Ingels Jr., et al.: Effect of intrathoracic pressure on left ventricular performance. N Engl J Med. 301:453-459 1979

6) Meert KL, McCaulley L, Sarnaik AP. Mechanism of lactic acidosis in children with acute severe asthma. Pediatr Crit Care Med. 2012 Jan;13(1):28-31

7) Stephanopoulos, R. Monge, K.H. Schell, et al.:Continuous intravenous terbutaline for pediatric status asthmaticus. Crit Care Med. 26:1744-1748 1998

8) R.W. Katz, H.W. Kelly, M.R. Crowley, et al.: Safety of continuous nebulized albuterol for bronchospasm in infants and children. Pediatrics. 92:666-669 1993

9) N.J. Gross: Ipratropium bromide. N Engl J Med.319:486-494 1988

10) D. Craven, C.M. Kercsmar, T.R. Myers, et al.:Ipratropium bromide plus nebulized albuterol for the treatment of hospitalized children with acute asthma. J Pediatr. 138:51-58 2001

11) R.A. Silverman, H. Osborn, J. Runge, et al.: IV magnesium sulfate in the treatment of acute severe asthma: a multicenter randomized controlled trial. Chest.122:489-497 2002

12) L. Ciarallo, A.H. Sauer, M.W. Shannon: Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial.J Pediatr. 129:809-814 1996

13) O.A. Akingbola, N. Simakajornboon, E.F. Hadley Jr., et al.: Noninvasive positive-pressure ventilation in pediatricstatus asthmaticus. Pediatr Crit Care Med. 3:181-1842002

14) M. Aubier, A. De Troyer, M. Sampson, et al.:Aminophylline improves diaphragmatic contractility. N Engl J Med. 305:249-252 1981

15) V.K. Gupta, I.M. Cheifetz: Heliox administration in the pediatric intensive care unit: an evidence-based review.Pediatr Crit Care Med. 6:204-211 2005

16) I.K. Kim, E. Phrampus, S. Venkataraman, et al.:Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, controlled trial. Pediatrics.116:1127-1133 2005

17) C.S. L’Hommedieu, J.J. Arens: The use of ketamine for the emergency intubation of patients with status asthmaticus. Ann Emerg Med. 16:568-571 1987

18) J.D. Tobias, J.S. Garrett: Therapeutic options for severe, refractory status asthmaticus: inhalational anaesthetic agents, extracorporeal membrane oxygenation and helium/oxygen ventilation. Paediatr Anaesth. 7:47-57 1997

19) C.H. Scoggin, S.A. Sahn, T.L. Petty: Status asthmaticus. A nine-year experience. JAMA. 238:1158-1162 1977

20) T.E. Stewart, A.S. Slutsky: Occult, occult auto-PEEP instatus asthmaticus. Crit Care Med. 24:379-380 1996

21) R.C. Wetzel: Pressure-support ventilation in children with severe asthma. Crit Care Med. 24:1603-1605 1996

22) D. Bohn, N. Kissoon: Acute asthma. Pediatr Crit Care Med. 2:151-163 2001

23) R. Stein, G.J. Canny, D.J. Bohn, et al.: Severe acute asthma in a pediatric intensive care unit: six years’ experience. Pediatrics. 83:1023-1028 1989