2,052 results match your criteria: "Status Asthmaticus"

Status Asthmaticus: Approaches in Mechanical Ventilation.

Pediatr Crit Care Med

December 2024

Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile.

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Article Synopsis
  • The study investigates the practice of withholding oral nutrition from children with critical asthma receiving continuous albuterol in a pediatric ICU, aiming to determine its safety and effects on respiratory failure.
  • A retrospective analysis was conducted with 36 cases (children receiving nutrition) and 72 matched controls (children not receiving nutrition), focusing on outcomes like aspiration-related respiratory failure and the duration of albuterol treatment.
  • Findings indicated no respiratory failure events in either group, with those receiving nutrition having longer albuterol treatment durations but similar outcomes in terms of length of stay and mortality, suggesting that withholding nutrition may not be necessary.
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Background: Current knowledge of the impact of socioeconomic factors on the risk of admission to the pediatric intensive care unit (PICU) for asthma is limited. Using composite measures of social vulnerability-Social Vulnerability Index (SVI) and Child Opportunity Index (COI) 2.0-we compared patients admitted for status asthmaticus to the PICU and pediatric ward at Children's Hospital Los Angeles (CHLA).

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A Multifaceted Exploration of Status Asthmaticus: A Retrospective Analysis in a Romanian Hospital.

J Clin Med

November 2024

Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), Pulmology University Clinic, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Square no. 2, 300041 Timisoara, Romania.

: Status asthmaticus is a severe, life-threatening asthma exacerbation requiring urgent medical intervention. This study aims to examine its epidemiology in Timis County, Romania, over 11 years. : A retrospective analysis was conducted using hospital records from 2013 to 2023, focusing on demographic, geospatial, and temporal distributions.

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To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving "usual-dose" (<4 mg/kg/day methylprednisolone equivalents) versus "high-dose" (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups.

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Background: To conduct a systematic review looking into the use of sevoflurane in the management of status asthmaticus (SA) in adults.

Methods: We performed a systematic search on PubMed, EMBASE, and The Cochrane Library - CENTRAL through 23rd August 2023, restricting to studies reported in English. We included studies reporting use of sevoflurane in asthmatics beyond its use as an anaesthetic agent in surgeries i.

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Article Synopsis
  • The study investigates how preterm birth affects the likelihood and severity of asthma and atopic dermatitis (AD) in children, using data from over 2.2 million infants in South Korea from 2007 to 2014.
  • It categorizes infants into three groups based on gestational age: extremely preterm, other preterm, and full-term, and defines asthma and AD based on specific clinical visit and diagnosis criteria within the first six years of life.
  • Findings suggest that preterm infants, particularly those with bronchopulmonary dysplasia, have a higher risk of developing asthma but a lower risk of AD; other conditions like neonatal sepsis and jaundice also contribute to asthma risk.
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Pediatric critical asthma, or formerly known as status asthmaticus, is a common pediatric condition encountered in emergency departments, hospital wards, and pediatric intensive care units. Systemic corticosteroids and inhaled bronchodilators are evidence-based, initial treatments for patients with pediatric critical asthma. If clinical symptoms do not improve, pediatric practitioners often prescribe adjunctive medications including inhaled anticholinergics, intravenous ketamine, intravenous magnesium, intravenous short acting beta 2 agonists, and intravenous methylxanthines (such as aminophylline).

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Inhaled Corticosteroids Use Before Hospitalization May Be Protective in Children With Direct Lung Injury.

CHEST Crit Care

June 2024

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, the Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

Article Synopsis
  • Systemic corticosteroids for acute respiratory failure have mixed results due to side effects, but inhaled corticosteroids (ICSs) might help prevent respiratory failure in children with direct lung injury (DLI).* -
  • The study analyzed data from 35,220 pediatric patients and found that those who received ICSs had significantly lower rates of intubation and the need for noninvasive respiratory support compared to those who did not.* -
  • The protective effect of ICSs was particularly strong in children with a history of asthma, suggesting that ICSs may be more effective in this subgroup.*
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  • In Kentucky, a study examined children with status asthmaticus (SA) in the Pediatric Intensive Care Unit (PICU) who received treatments like inhaled volatile anesthetics (IVA) and/or Extracorporeal Membrane Oxygenation (ECMO).
  • Out of 1772 children with SA, seven received rescue therapies: one received only IVA, five received both IVA and ECMO, and one received only ECMO; all had undergone standard asthma treatments before escalation.
  • The findings suggest that while there wasn't a clear benefit of using IVA before ECMO, many patients transitioned to ECMO, hinting that earlier ECMO interventions might be more advantageous despite the risks and high costs involved.
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Status Asthmaticus in the Pediatric ICU: A Comprehensive Review of Management and Challenges.

Pediatr Rep

July 2024

Pediatric Critical Care Medicine, Pediatric Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.

This narrative review addresses the significant burden of pediatric status asthmaticus, which comprises almost 20% of admissions to pediatric intensive care units (PICUs). It highlights the diverse modalities employed in the PICU for managing this life-threatening condition, and thoroughly discusses the literature in support of or against these treatment modalities.

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Acute severe asthma, formerly named status asthmaticus, is defined as a life-threatening asthma exacerbation that is refractory to the current standards of treatment such as the use of beta-agonists and epinephrine. This complication of asthma affects up to 15% of individuals with asthma and despite critical care treatment and hospitalization, there remains a staggeringly high 10-18% mortality rate in an intensive care unit setting. The addition of ketamine to the arsenal of acute severe asthma treatment due to its rapid onset, variable routes of administration, and overall improved clinical efficacy in treatment-refractory cases has been well investigated and documented.

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Objective: We aimed to characterize intravenous (IV) methylprednisolone (MP) dosing regimens and clinical outcomes for children hospitalized for critical asthma (CA).

Methods: A single-center, retrospective review was performed of children admitted to the pediatric intensive care unit (PICU) for CA between September 2015 and October 2019. Patients 5-to 17-year-olds, initiated on continuous nebulized albuterol, and prescribed at least one dose of IV MP were included.

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Objectives: Dexamethasone has become the standard of care for pediatric patients with status asthmaticus in the emergency department (ED) setting. Inpatient providers often must decide between continuing the second dose of dexamethasone or transitioning to prednisone. The effectiveness of receiving dexamethasone followed by prednisone (combination therapy) compared to only prednisone or dexamethasone remains unclear.

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The use of sedatives in Intensive Care Units (ICU) is essential for relieving anxiety and stress in mechanically ventilated patients, and it is related to clinical outcomes, duration of mechanical ventilation, and length of stay in the ICU. Inhaled sedatives offer benefits such as faster awakening and extubation, decreased total opioid and neuromuscular blocking agents (NMB) doses, as well as bronchodilator, anticonvulsant, and cardiopulmonary and neurological protective effects. Inhaled sedation is administered using a specific vaporizer.

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Article Synopsis
  • The study aimed to compare the effectiveness of different doses of nebulized magnesium sulphate combined with Salbutamol in treating status asthmaticus in children aged 2-12 years.
  • Conducted at Dr. Ziauddin University Hospital in Pakistan, the clinical trial involved 104 children, assessing asthma severity using the Pediatric Rapid Assessment Measure (PRAM) score before and after treatment.
  • Results indicated significant improvements in asthma symptoms over time, with higher doses of magnesium sulphate combined with Salbutamol leading to greater reductions in PRAM scores compared to Salbutamol alone.
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Background: We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress. This is of interest as the patient had no other symptomatology, especially given the size of the mass, which would typically cause a pressure effect leading to neurological and auditory symptoms.

Case Summary: This case report described a 48-year-old male who was married with two children and employed as a car guard.

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Background: Asthma is defined by the Global Initiative for Asthma (GINA) as a heterogeneous disease characterized by chronic airway inflammation. The pathogenesis of the disease is better understood with the comprehension of immunological pathways. These pathways differ by the type of recruited cells and released interleukin (IL).

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Background: Patients with status asthmaticus (SA) frequently present with lactic acidosis (LA). Our goal is to identify the nature of this LA using the Stewart physicochemical model and to identify the independent factors associated with LA in children with SA.

Methods: Analytical study of a retrospective cohort using a nested case-control design.

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Inhaled volatile anesthetics in the intensive care unit.

World J Crit Care Med

March 2024

Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States.

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres, finding diverse applications in intensive care settings. In the dynamic landscape of intensive care, volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements, managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus, conditions of high sedative requirements including burns, high opioid or alcohol use and neurological conditions such as status epilepticus.

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The chronic inflammatory component of asthma is propagated by granulocytes, including neutrophils and eosinophils, in the peripheral circulation and airway. Previous studies have suggested that these cells have an altered expression of adhesion-related molecules and a propensity for the release of granule contents that may contribute to tissue damage and enhance inflammatory complications in patients with status asthmaticus. The goal of this prospective cohort study at a tertiary care pediatric hospital with a large population of asthma patients was to assess the role of granulocyte-based inflammation in the development of asthma exacerbation.

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Background: In this narrative review we aimed to explore outcomes of extracorporeal life support (extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R)) as rescue therapy in patients with status asthmaticus requiring mechanical ventilation.

Methods: Multiple databases were searched for studies fulfilling inclusion criteria. Articles reporting mortality and complications of ECMO and ECCO2R in mechanically ventilated patients with acute severe asthma (ASA) were included.

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Use of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in near-fatal asthma: a case series.

Multidiscip Respir Med

February 2024

Department of Internal Medicine, Pulmonology Service, Fundación Valle del Lili, Cali, Colombia.

Introduction: Status asthmaticus (SA) and near-fatal asthma (NFA) are life-threatening conditions that continue to present a management challenge for physicians. Extracorporeal Membrane Oxygenation (ECMO) has been employed as a last resort in treating these patients.

Case Presentation: We described six patients who were admitted to the ICU for NFA and received ECMO treatment at a high-complexity institution in Cali, Colombia, between 2015 and 2019.

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Status asthmaticus is a severe form of aggravation of asthma, whereas myasthenia gravis (MG) is a rare neuromuscular condition characterised by exhaustion and muscle weakness. Myasthenic crisis can occasionally manifest with symptoms that resemble status asthmaticus, which can result in an incorrect diagnosis and ineffective therapy. In addition to discussing the therapeutic implications, this abstract attempts to draw attention to the difficulties in distinguishing between status asthmaticus and myasthenia crisis and the importance of diagnosing subtle signs of MG.

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Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases.

J Clin Med

February 2024

Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy.

Article Synopsis
  • Neuromuscular blocking agents (NMBAs) are frequently used in ICU settings for critically ill patients to enhance mechanical ventilation, alleviate breathing effort, and minimize complications like patient-ventilator mismatch, particularly in lung disease cases like ARDS.
  • Despite their benefits, current guidelines show mixed opinions on the routine use of NMBAs, especially in conditions like status asthmaticus or acute COPD exacerbations, where their application is sometimes debated.
  • Concerns over adverse effects such as immobilization, venous issues, and potential long-term complications have led to a decline in NMBA use over the last ten years, prompting a re-evaluation of their role in managing patients with severe respiratory issues.
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