“Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or a carbon dioxide tension >50Hg with or without altered level of consciousness, requiring mechanical ventilation”.
Though millions of children in the US suffer from asthma, with status asthmaticus being the most common medical emergency, there is limited information on mechanically ventilated critically ill children with status asthmaticus.
In the Pediatric Intensive Care Unit (PICU) beta-2 agonists are administered by inhalation in large doses. This treatment may result in irritability, tremor and tachycardia all of which may worsen the states of the hypoxic child. “Dex is a sedative with favorable respiratory and cardiovascular properties (and may be anti-inflammatory). Adding low-dose intravenously (IV) administered Dex appears efficacious in the treatment of near-fatal asthma in adults. No significant data exists for this management of severe asthmatic children.
A record-database observational study of 13 children (9 months -15 years of age) with near fatal severe asthma describes the use of IV Dex with continuous beta-2 agonist administration, following standard care.
Children with near fatal asthma following standard therapy including mechanical ventilation, treated with continuous salbutamol inhalation combined with intravenous Dex tolerate treatment well and appear to improve significantly (hypokalemia may occur with high doses of salbutamol).
