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Status Asthmaticus in Children

A Review
  • Heinrich A. Werner
    Correspondence
    Correspondence to: Heinrich A. Werner, MD, Division of Critical Care, University of Kentucky Children’s Hospital, Lexington, KY 40536
    Affiliations
    Division of Critical Care, University of Kentucky Children’s Hospital, Lexington, KY
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      About 10% of American children have asthma, and its prevalence, morbidity, and mortality have been increasing. Asthma is an inflammatory disease with edema, bronchial constriction, and mucous plugging. Status asthmaticus in children requires aggressive treatment with β-agonists, anticholinergics, and corticosteroids. Intubation and mechanical ventilation should be avoided if at all possible, as the underlying dynamic hyperinflation will worsen with positive-pressure ventilation. If mechanical ventilation becomes necessary, controlled hypoventilation with low tidal volume and long expiratory time may lessen the risk of barotrauma and hypotension. Unusual and nonestablished therapies for severe asthma are discussed.

      Key words

      Abbreviations:

      cAMP (cyclicadenosine monophosphate), DHI (dynamic hyperinflation), ECLS (extracorporeal life support), e-NANC (excitatory orstimulatory nonadrenergic-noncholinergic), i-NANC (inhibitorynonadrenergic-noncholinergic), NANC (nonadrenergic-noncholinergic), NO (nitric oxide), PC (pressure control), PEEP (positiveend-expiratory pressure), PKA (protein kinase A), PRVC (pressure-regulated volume control), PS (pressure support), PSV (pressure-support ventilation), VIP (vasoactive intestinalpeptide)
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