ABSTRACT
Acute severe paediatric asthma remains a serious and debilitating disease throughout the world. The incidence and mortality from asthma continue to increase. Early, effective and aggressive outpatient therapy is essential in reducing symptoms and preventing life-threatening progression. When complications occur or when the disease progresses to incipient respiratory failure, these children need to be managed in a continuous care facility where aggressive and potentially dangerous interventions can be safely instituted to reverse persistent bronchospasm. The primary drugs for acute severe asthma include oxygen, corticosteroids, salbutamol (albuterol) and anticholinergics. Second-line drugs include heliox, magnesium sulfate, ketamine and inhalational anaesthetics. Future therapies may include furosemide, leukotriene modifiers, antihistamines and phosphodiesterase inhibitors. This review attempts to explore the multitude of medications available with emphasis on pharmacology and pathophysiology.
Subject(s)
Asthma/drug therapy , Child, Hospitalized/statistics & numerical data , Asthma/epidemiology , Asthma/physiopathology , Child , HumansABSTRACT
The best ICU monitors are physicians and nurses, who integrate all of the physiologic parameters of patients with the known pathophysiology of the disease process. Over-reliance on raw electronic data, with their inherent errors, jeopardizes the safe and efficient care of patients. Data must be interpreted in the context of the history, repetitive physical examinations, response to therapy, and a background of experience. New modalities and the application of artificial intelligence may facilitate the interpretation of data, but the role of the bedside medical practitioner remains as the heart of pediatric critical care.
Subject(s)
Intensive Care Units, Pediatric , Monitoring, Physiologic/methods , Blood Gas Monitoring, Transcutaneous/methods , Child , Electroencephalography , Hemodynamics/physiology , Humans , Nitric Oxide/metabolism , Oximetry/methods , Point-of-Care Systems/organization & administrationABSTRACT
Drowning and near drowning remain a common cause of childhood death and disability. Toddlers aged one through four drown in private swimming pools. Submersions greater than 10 minutes and lack of CPR at the scene or the need for greater than 20 minutes of resuscitation portends a poor prognosis. Management of respiratory failure without neurologic impairment has the most successful outcome. Prevention of drowning morbidity is dependent on constant parental supervision, and immediate and expert CPR.
Subject(s)
Drowning , Near Drowning , Adolescent , Adult , Child , Child, Preschool , Drowning/epidemiology , Drowning/physiopathology , Drowning/prevention & control , Emergency Medical Services , Female , Humans , Infant , Male , Near Drowning/epidemiology , Near Drowning/physiopathology , Near Drowning/prevention & control , Near Drowning/therapy , Resuscitation/methods , Risk Factors , SafetyABSTRACT
Status asthmaticus is complex in its etiology and pathophysiology and may be associated with significant morbidity and mortality. Although there are many therapeutic options, specific inhaled beta 2-agonists, corticosteroids, and oxygen remain the mainstay of therapy. Several new drugs and some older drugs are being used in management; their exact role in treatment at present, however, relies largely on personal preferences. Innovative methods of providing ventilatory support are also emerging. What is quite clear is the fact that involvement of specialists (pulmonologists and intensivists) early in the course of severe status asthmaticus is needed to ensure optimal management and possibly favorable outcomes.
Subject(s)
Critical Care , Pediatrics , Status Asthmaticus/therapy , Adolescent , Child , Child, Preschool , Critical Illness , Humans , Infant , Male , Respiration, Artificial , Status Asthmaticus/drug therapyABSTRACT
A multi-institutional, pediatric intensive care program initiated in Jacksonville, Florida, is a systematic approach to critical care which avoids costly duplication and provides efficient clinical services and an academic fellowship program. A total of 6,876 consecutive admissions to the two units over a seven-year period are discussed and compared to national data. A coordinated system may provide a model for other communities; however, the ability to expand services in a market where public and private third party funding is being reduced may become a problem.
Subject(s)
Critical Care , Pediatrics , Regional Medical Programs , Adolescent , Child , Child, Preschool , Critical Care/economics , Critical Care/organization & administration , Critical Care/statistics & numerical data , Female , Florida/epidemiology , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric/economics , Intensive Care Units, Pediatric/organization & administration , Intensive Care Units, Pediatric/statistics & numerical data , Male , Patient Admission/statistics & numerical data , Regional Medical Programs/economics , Regional Medical Programs/organization & administration , Regional Medical Programs/statistics & numerical data , Reimbursement Mechanisms , Severity of Illness IndexABSTRACT
Use of halothane anesthesia for treating respiratory failure caused by status asthmaticus in children is highly controversial. Previous reports suggest that bronchodilation occurs within minutes of administration. This report describes the case of a child who received five and a half hours of halothane in conjunction with isoproterenol and theophylline to reverse respiratory failure. Halothane did not significantly improve ventilation, and it was associated with significant hemodynamic complications. The use of newer beta-2-agonists and anticholinergics is discussed.
