Acute Management of the Pediatric Asthmatic Patient in Respiratory Failure: An Overview

Abstract

The recent literature has been reviewed to define guidelines for the care of children critically ill with status asthmaticus, with the following findings: Careful objective clinical assessment and serial blood gas measurements will indicate the presence of respiratory failure. Mechanical ventilation may become necessary to reverse hypoxia, hypercapnia, and respiratory acidosis, with sedation and neuromuscular-blocking agents usually required to facilitate intubation and synchronous ventilatory assis-tance. An understanding of the basic pathophysiological characteristics of the asth-matic lung is essential to achieve optimal ventilation. Corticosteroids, intravenous methylxanthines, and beta-2 sympathomimetic bronchodilators should be continued during and after mechanical ventilation. When a systematic and thoughtful approach is used to manage and monitor the pediatric asthmatic patient, complications are minimized and the prognosis for the patient is optimized.