Current management of status asthmaticus in the pediatric ICU.
Status asthmaticus (SA) in the pediatric ICU (PICU) can progress to a life-threatening emergency. The goal of management is to improve hypoxemia, improve bronchoconstriction, and decrease airway edema through the administration of continuous nebulized beta2 adrenergic agonist with intermittent anticholinergics, corticosteroids, and oxygen. Adjunctive therapies, such as magnesium, methylxanthines, intravenous beta-agonists, heliox, and noninvasive ventilation should be considered in the child who fails to respond to initial therapies. The restoration of adequate pulmonary functions, resolution of airway obstruction, and avoidance of mechanical ventilation should guide management. This article reviews the pathophysiology, assessment, and management of the child who has SA in the PICU to provide the critical care nurse with current information to facilitate optimal care.
Marcoux
Kelly Keefe
KK
Department of Pediatrics, UMDNJ/Robert Wood Johnson Medical School, USA. marcoukk@umdnj.edu
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003422:Critical Care / Q000458:organization & administration*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008487:Medical History Taking; D024802:Nurse's Role; D009730:Nursing Assessment; D010092:Oximetry / Q000451:nursing; D010102:Oxygen Inhalation Therapy / Q000451:nursing; D010371:Pediatric Nursing / Q000458:organization & administration*; D010808:Physical Examination / Q000451:nursing; D019095:Point-of-Care Systems; D012121:Respiration, Artificial / Q000451:nursing; D012129:Respiratory Function Tests / Q000451:nursing; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D014481:United States / Q000453:epidemiology
D000316:Adrenergic alpha-Agonists; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists