Document Detail


Efficacy, results, and complications of mechanical ventilation in children with status asthmaticus.
MedLine Citation:
PMID:  1758729     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We have conducted a retrospective survey of 79 children out of a total hospital asthmatic patient population of 2,412, admitted over a 32 month period to the ICU for the management of severe status asthmaticus. All patients were in severe respiratory distress with CO2 retention; 19 required mechanical ventilation due to increasing fatigue and worsening bronchospasm, having failed to respond to either inhaled or IV bronchodilator therapy. All patients were ventilated at slow rates (less than 12 min) and their airway pressure (Paw) was deliberately kept below 45 cmH2O, while accepting a PaCO2 in the 45-60 mmHg range, as long as the pH was compensated. Although two patients developed pneumothoraces while on positive pressure ventilation, these were resolved without incidents. Five patients who had mediastinal or subcutaneous air leaks prior to intubation did not develop pneumothoraces. Following the initiation of mechanical ventilation, IV beta-agonist therapy was increased in order to reverse the bronchospasm and reduce the duration of mechanical ventilation. Mean duration of intubation was 42 hours. Fourteen of the 19 patients were weaned and extubated within 48 hours. All patients survived without sequelae. We conclude that a degree of controlled "hypoventilation" by deliberately choosing Paw less than 45 cmH2O can be successfully used to ventilate children with severe status asthmaticus with a reduced rate of pressure-related complications.
Authors:
R G Cox; G A Barker; D J Bohn
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  11     ISSN:  8755-6863     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  1991  
Date Detail:
Created Date:  1992-02-06     Completed Date:  1992-02-06     Revised Date:  2006-03-28    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  120-6     Citation Subset:  IM    
Affiliation:
Pediatric Intensive Care Unit, Hospital for Sick Children, Toronto, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Airway Resistance / physiology*
Bronchodilator Agents / administration & dosage*
Carbon Dioxide / blood
Child
Child, Preschool
Combined Modality Therapy
Female
Follow-Up Studies
Humans
Hydrogen-Ion Concentration
Infant
Male
Oxygen / blood
Oxygen Inhalation Therapy* / adverse effects
Respiration, Artificial* / adverse effects
Status Asthmaticus / complications,  physiopathology,  therapy*
Chemical
Reg. No./Substance:
0/Bronchodilator Agents; 124-38-9/Carbon Dioxide; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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