Duration of mechanical ventilation in life-threatening pediatric asthma: Description of an acute asphyxial subgroup

被引:23
作者
Maffei, FA [1 ]
van der Jagt, EW [1 ]
Powers, KS [1 ]
Standage, SW [1 ]
Connolly, HV [1 ]
Harmon, WG [1 ]
Sullivan, JS [1 ]
Rubenstein, JS [1 ]
机构
[1] Univ Rochester, Strong Childrens Res Ctr, Div Pediat Crit Care, Rochester, NY USA
关键词
acute asphyxial asthma; rapid onset near-fatal asthma; respiratory failure; mechanical ventilation;
D O I
10.1542/peds.2004-0294
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective. Acute asphyxial asthma ( AAA) is well described in adult patients and is characterized by a sudden onset that may rapidly progress to a near-arrest state. Despite the initial severity of AAA, mechanical ventilation often restores gas exchange promptly, resulting in shorter durations of ventilation. We believe that AAA can occur in children and can lead to respiratory failure that requires mechanical ventilation. Furthermore, children with rapid-onset respiratory failure that requires intubation in the emergency department (ED) are more likely to have AAA and a shorter duration of mechanical ventilation than those intubated in the pediatric intensive care unit (PICU). Methods. An 11-year retrospective chart review ( 19912002) was conducted of all children who were aged 2 through 18 years and had the primary diagnosis of status asthmaticus and required mechanical ventilation. Results. During the study period, 33 (11.4%) of 290 PICU admissions for status asthmaticus required mechanical ventilation. Thirteen children presented with rapid respiratory failure en route, on arrival, or within 30 minutes of arrival to the ED versus 20 children who progressed to respiratory failure later in their ED course or in the PICU. Mean duration of mechanical ventilation was significantly shorter in the children who presented with rapid respiratory failure versus those with progressive respiratory failure ( 29 +/- 43 hours vs 88 +/- 72 hours). Children with rapid respiratory failure had greater improvements in ventilation and oxygenation than those with progressive respiratory failure as measured by pre- and postintubation changes in arterial carbon dioxide pressure, arterial oxygen pressure/fraction of inspired oxygen ratio, and alveolar-arterial gradient. According to site of intubation, 23 children required intubation in the ED, whereas 10 were intubated later in the PICU. Mean duration of mechanical ventilation was significantly shorter in the ED group versus the PICU group ( 42 +/- 63 hours vs 118 +/- 46 hours). There were significantly greater improvements in ventilation and oxygenation in the ED group versus the PICU group as measured by pre- and postintubation changes in arterial carbon dioxide pressure and arterial oxygen pressure/fraction of inspired oxygen ratio. Conclusions. AAA occurs in children and shares characteristics seen in adult counterparts. Need for early intubation is a marker for AAA and may not represent a failure to maximize preintubation therapies. AAA represents a distinct form of life-threatening asthma and requires additional study in children.
引用
收藏
页码:762 / 767
页数:6
相关论文
共 27 条
[1]   LYMPHOCYTES-T AND ACTIVATED EOSINOPHILS IN AIRWAY MUCOSA IN FATAL ASTHMA AND CYSTIC-FIBROSIS [J].
AZZAWI, M ;
JOHNSTON, PW ;
MAJUMDAR, S ;
KAY, AB ;
JEFFERY, PK .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 145 (06) :1477-1482
[2]   Airway structure and inflammatory cells in fatal attacks of asthma [J].
Carroll, N ;
Carello, S ;
Cooke, C ;
James, A .
EUROPEAN RESPIRATORY JOURNAL, 1996, 9 (04) :709-715
[3]   EFFICACY, RESULTS, AND COMPLICATIONS OF MECHANICAL VENTILATION IN CHILDREN WITH STATUS-ASTHMATICUS [J].
COX, RG ;
BARKER, GA ;
BOHN, DJ .
PEDIATRIC PULMONOLOGY, 1991, 11 (02) :120-126
[4]   Cellular responses to mechanical stress invited review:: Mechanisms of ventilator-induced lung injury:: a perspective [J].
Dos Santos, CC ;
Slutsky, AS .
JOURNAL OF APPLIED PHYSIOLOGY, 2000, 89 (04) :1645-1655
[5]   MECHANICAL VENTILATION FOR STATUS-ASTHMATICUS IN CHILDREN [J].
DWORKIN, G ;
KATTAN, M .
JOURNAL OF PEDIATRICS, 1989, 114 (04) :545-549
[6]   ANTIGEN-INDUCED ACUTE AND LATE-PHASE RESPONSES IN PRIMATES [J].
GUNDEL, RH ;
WEGNER, CD ;
LETTS, LG .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 146 (02) :369-373
[7]  
HUNT LW, 1992, J ALLERGY CLIN IMMUN, V89, P334
[8]   EARLY AND LATE-PHASE BRONCHOCONSTRICTION AFTER ALLERGEN CHALLENGE OF NONANESTHETIZED GUINEA-PIGS .1. THE ASSOCIATION OF DISORDERED AIRWAY PHYSIOLOGY TO LEUKOCYTE INFILTRATION [J].
HUTSON, PA ;
CHURCH, MK ;
CLAY, TP ;
MILLER, P ;
HOLGATE, ST .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1988, 137 (03) :548-557
[9]   Rapid onset asthma: a severe but uncommon manifestation [J].
Kolbe, J ;
Fergusson, W ;
Garrett, J .
THORAX, 1998, 53 (04) :241-247
[10]   Mechanical ventilation in children with severe asthma [J].
Malmström, K ;
Kaila, M ;
Korhonen, K ;
Dunder, T ;
Nermes, M ;
Klaukka, T ;
Sarna, S ;
Juntunen-Backman, K .
PEDIATRIC PULMONOLOGY, 2001, 31 (06) :405-411