Abstract

Severe bronchial asthma in PICU where we are now

Severe acute asthma (SAA), also known as status asthmatics, is a severe or life-threatening asthma exacerbation, which does not respond to conventional treatment with inhaled short acting beta-agonist (SABA) and systemic corticosteroids. SAA has the potential to progress to respiratory failure and can be fatal. SAA requiring admission to the pediatric intensive care unit (PICU) occurs in approximately 5–16% of all asthma hospitalizations. Recent reports demonstrate increasing numbers of children requiring PICU admission in several countries across the world. Most pediatric asthma guidelines offer evidence-based approaches to the management of asthma exacerbations (oxygen, inhaled beta-agonists, and systemic corticosteroids). However, they struggle with an evidence-based approach for SAA beyond these initial steps. There is a broad arsenal of adjunct therapies in case the child is not responding to conventional treatment, but the evidence is often unclear, conflicting or absent in the context of PICU care in literature. Adjunct therapies that are often suggested in children with SAA are intravenous (IV) magnesium sulfate (MgSO4), IV theophylline, and IV salbutamol. We will discuss the current practice in management of severe bronchial asthma in PICU.


Author(s): Mohamed Ebraheem Elmesserey

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