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At least 19 recordsLinked to original sources
PubMed2005

[Status asthmaticus].

Status asthmaticus, the most severe form of asthma exacerbation, is a life-threatening condition. The mortality rate in status asthmaticus ranges from 3.5% to 8.3%. Therapeutic approach in acute severe asthma is based on oxygen supply, high doses of nebulised beta2-agonists and systemic corticosteroids administered intravenously or orally. Second line therapy is comprised of methyloxantines, nebulised cholinolitics and management of electrolytes and water balance. Status asthmaticus resulting in acute respiratory failure will often require invasive or non-invasive mechanical ventilation. Mortality in patients with asthma who require mechanical ventilation might exceed 20%. International guidelines for management of status asthmaticus have been published recently, but those recommendations often remain unknown. Thus there is an urgent need for elaboration of national standards on managing acute severe asthma and putting it into clinical practice. Status asthmaticus, especially a severe one, should be treated in a respiratory intermediate intensive care unit.

Adrenal Cortex Hormones↗
PubMed2002

Management of respiratory failure in status asthmaticus.

Status asthmaticus is a life-threatening episode of asthma that is refractory to usual therapy. Recent studies report an increase in the severity and mortality associated with asthma. In the airways, inflammatory cell infiltration and activation and cytokine generation produce airway injury and edema, bronchoconstriction and mucus plugging. The key pathophysiological consequence of severe airflow obstruction is dynamic hyperinflation. The resulting hypoxemia, tachypnea together with increased metabolic demands on the muscles of respiration may lead to respiratory muscle failure. The management of status asthmaticus involves intensive pharmacological therapy particularly with beta-adrenoceptor agonists (beta-agonists) and corticosteroids. Albuterol (salbutamol) is the most commonly used beta2-selective inhaled bronchodilator in the US. Epinephrine (adrenaline) or terbutaline, administered subcutaneously, have not been shown to provide greater bronchodilatation compared with inhaled beta-agonists. Corticosteroids such as methylprednisolone should be administered early. Aerosolized corticosteroids are not recommended for patients with status asthmaticus. Inhaled anticholinergic agents may be useful in patients refractory to inhaled beta-agonists and corticosteroids. In patients requiring mechanical ventilation, the strategy aims to avoid dynamic hyperinflation by enhancing expiratory time to allow complete exhalation. Complications of dynamic inflation are hypotension and barotrauma. Sedation with opioids, benzodiazepines or propofol is required to facilitate ventilator synchrony but neuromuscular blockade should be avoided as myopathy has been a reported complication. Overall, in the management of patients with status asthmaticus, the challenge to the pulmonary/critical care clinician is to provide optimal pharmacological and ventilatory support and avoid the adverse consequences of dynamic hyperinflation.

Anti-Asthmatic Agents↗
PubMed2000

Mechanical ventilation for children with status asthmaticus.

Status asthmaticus is the most common diagnosis leading to hospital admission in childhood. Most of these patients respond well to oxygen, steroids, beta-agonists, anticholinergics, and other medications. The few patients who develop respiratory failure from severe status asthmaticus pose many challenges to those supporting them in the intensive care unit. This Article discusses the pathophysiology of asthma and how that relates to appropriate ventilator management. Alternative therapies are briefly discussed.

Administration, Inhalation↗
PubMed1991

Management of status asthmaticus.

Status asthmaticus is a medical emergency that requires careful evaluation and aggressive therapy. The mainstay of medical therapy is frequent administration of beta-agonist inhalations, combined with early corticosteroid use. Intravenous magnesium can be used as an adjunctive measure. If available, nebulized ipratropium bromide can be added to the regimen if side effects or poor response occurs to maximal dosages of beta-agonists. Nonconventional therapies should be considered only if conventional treatment fails. Signs and symptoms of deteriorating airflow and respiratory muscle fatigue should determine the need for mechanical ventilation. If mechanical ventilation is required, controlled hypoventilation may be best.

Humans↗
PubMed1993

Extracorporeal life support for status asthmaticus.

Status asthmaticus is a life-threatening form of reactive airway disease, refractory to initial control with ordinary medical measures, sometimes requiring mechanical ventilatory assistance. In this report, we describe a patient whose bronchospasm could not be controlled with conventional measures, with severe respiratory acidosis (PaCO2 consistently > 100 mm Hg), who was successfully supported with extracorporeal life support (ECLS). During ECLS, arterial blood gas values rapidly returned to normal, and bronchospasm resolved during the subsequent 24 h. The patient was extubated hours later, and discharged to home 4 days later, neurologically normal. We believe that this represents the first application of this technology to this disease in an adult patient.

Adult↗
PubMedDate not supplied

Characteristics of the Inflammatory response in bronchial lavage fluids from patients with status asthmaticus.

Status asthmaticus (SA) is a sudden respiratory failure characterized by an acute bronchospasm with a severe inflammation, requiring in some cases mechanical ventilation (MV). Initial postmortem studies emphasized the presence of eosinophils in the bronchial wall and of mucus plugs filling the bronchi. More recently a prominent neutrophil influx was observed in patients with fatal or near fatal asthma. The aim of our study was to evaluate characteristics of bronchial inflammation in terms of cellular influx, mediators, cytokines and chemokines. Ten patients with SA were compared with 11 patients with chronic asthma, 4 without preexisting pulmonary disease requiring MV and 8 healthy subjects. Bronchial lavages in SA were indicated to remove bronchial plugs in case of atelectasis and/or refractory SA. The main findings in patients with SA were a massive influx of neutrophils (81.5 +/- 4.5%) with a dramatic increase of neutrophil elastase. Although more limited than the neutrophil influx, eosinophils were present and associated with high levels of eosinophil cationic protein (ECP), which suggested that a part of the eosinophils were activated and degranulated. In parallel to the neutrophil and eosinophil influx, we observed elevated amounts of proinflammatory (IL-1beta, IL-5, IL-6, TNFalpha) and anti-inflammatory (IL-10, IL-1 receptor antagonist, soluble TNF receptors) cytokines with a balance in favor of a net proinflammatory activity. Chemokines were also present in large quantities with a predominance of MCP-1, MIP-alpha and RANTES with a significant correlation between MCP-1, RANTES, IL-5 and both eosinophil and ECP values. In addition an acute 10- to 160-fold increase of 92-kD gelatinase (MMP9) was detected in bronchial lavage fluid from patients with SA associated with a free metallogelatinolytic activity, suggesting an imbalance in the local production of proteases and antiproteases. Therefore, our results indicate that the bronchi in SA are the site of an intense production of pro- and anti-inflammatory cytokines and chemokines that are implicated in the influx of eosinophils and neutrophils. The inflammatory pattern in SA clearly differs from the usual profile observed in chronic asthma.

Bronchoalveolar Lavage Fluid↗
PubMed1999

Balance between proinflammatory cytokines and their inhibitors in bronchial lavage from patients with status asthmaticus.

Status asthmaticus (SA) is an acute respiratory failure combining an acute bronchospastic reaction with a severe airway inflammation. We previously reported an important influx of neutrophils and an increased secretion of interleukin-8 (IL-8) in patients with SA. The aim of this prospective study was to evaluate in bronchial lavage (BL) of patients with SA (n = 9) under mechanical ventilation (MV) the concentrations of cytokines and related mediators which have the ability to modulate inflammation, either proinflammatory (interleukin-1beta [IL-1beta], IL-6, tumor necrosis factor-alpha [TNF-alpha]), or anti-inflammatory mediators (IL-10, transforming growth factor-beta1 [TGF-beta1]), interleukin-1 receptor antagonist [IL-1Ra], soluble TNF receptor I and II [sTNFRI and II]). To determine the relative importance of both pro- and anti-inflammatory mediators, the net inflammatory activity was analyzed by the capacity of BL fluids (BLF) to increase intercellular adhesion molecule-1 (ICAM-1) expression in the human lung A549 epithelial cell line. These data were compared with those obtained from patients who required MV without respiratory disease (V, n = 4), controlled asthma (A, n = 11), and nonsmoking healthy volunteers (C, n = 8). Levels of IL-1, IL-6, TNF-alpha, and of the active form of TGF-beta1 were significantly higher in SA compared with the other groups. The concentrations of IL-1Ra, IL-10, the latent form of TGF-beta1, and of the sTNFRI and II were not significantly different between SA and V, albeit higher in SA than in A and C. The ratio between IL-1Ra and IL-1beta was significantly higher in patients with SA compared with the other groups, whereas there was no difference for the ratio between both types of sTNFR and TNF-alpha. Despite a marked increase of anti-inflammatory mediators in BL from patients with SA, the net inflammatory activity was found to be proinflammatory and mainly due to the presence of bioactive IL-1beta (79% inhibition of ICAM-1 expression with anti-IL-1beta antibodies) and to a lesser extent TNF-alpha (32% inhibition with anti-TNF-alpha antibodies).

Adult↗
PubMedDate not supplied

[Acid-base and gasometric findings at the admission of 150 children clinically diagnosed as in status asthmaticus].

"Status Asthmaticus" (SA) is a severe complication of asthma in which the clinical concept should be accompanied by biochemical alterations. Biochemical determinations were made on admission of 150 children clinically diagnosed as in SA. The Astrup method was used, following the technique advised by Stamm, Sharp and others. Most of the children were asthmatic grade III, with a predominance of the male sex, and 70.66% were in good nutrition. It was found that 90 patients had altered pCO2 (60%); 88 patients had a low per cent saturation of hemoglobin (58.66%), and 49 patients had altered pH (32.66%). Having in mind Bocles' classification for SA, it was observed that 30% of the children did not present biochemical alterations and could not be considered as in SA, in spite of the clinical impression. The rest of the patients really filled the criteria of SA and the most frequently found was Bocles' stage IV (41.33%), that is the most severe. Finally, considerations are made on the SA treatment, for the different Bocles' stages.

Acid-Base Equilibrium↗
PubMed1982

Status asthmaticus. Management of status asthmaticus complicated by surgical emphysema--avoidance of intermittent positive pressure ventilation.

The management of a case of status asthmaticus complicated by surgical emphysema is described. In view of voice changes, intubation was necessary but intermittent positive pressure ventilation was considered unwise, because of the surgical emphysema. A means of maintaining adequate sedation in an intubated patient whilst allowing spontaneous respiration is outlined.

Adult↗
PubMed1990

[Inhalation anesthetic therapy of status asthmaticus].

Status asthmatics is characterized pathologically by bronchial smooth muscle spasm, and mucous plugging of the small airways. Clinically, it is characterized by the disturbance of gas exchange. In severe cases, unresponsive to standard therapy (including oxygen, epinephrine, aminophylline and steroids, artificial ventilation, tracheobronchial lavage and inhalation), anesthetic therapy should be started without delay. Inhalation anesthetics, halothane or ether, have potent bronchodilating properties which facilitate the removal of mucous plugging. We reported nine cases with status asthmatics treated by inhalation anesthetic therapy. Halothane (0.5-3.0%) was used in all cases, ether (1.5-3.0 ml/kg) was used in five cases. The duration of anesthesia was 0.5 to 13.5 hours. In three halothane anesthesia cases, blood pressure was reduced before there was improvement in wheezing, so we were forced to change halothane to ether. In all cases, the symptoms of status asthmatics were improved, but two patients died due to other complications. We recommended the following method, viz that halothane be administered at first, and be changed to ether in order to maintain circulatory movement.

Adult↗
PubMed2005

[The investigation of isoflurane therapy for status asthmaticus patients].

Status asthmaticus is defined as an attack of bronchial asthma that resists conventional treatment and continues for more than 24 hours. We report here about patients with status asthmaticus who were successfully treated with isoflurane inhalation. Of the 19 patients who were transferred to the intensive care unit (ICU) and underwent mechanical ventilation from January 1996 to May 2001, eleven patients who were first treated by isoflurane inhalation were targeted in this study. Their improvement was assessed 6 and 24 hours after anesthesia compared with their condition before anesthesia. The tidal volume, pH, and PaCO2 improved within 6 hours after anesthesia. For the next step, among the patients who were transferred to the critical care center soon after an attack of bronchial asthma and underwent mechanical ventilation, 8 patients who were treated by isoflurane inhalation anesthesia (Group I) and another 4 patients who were not treated by isoflurane (Group NI) were compared to assess the usefulness of isoflurane inhalation therapy. The patients in Group I stayed in the ICU and underwent mechanical ventilation for a shorter period. These patients had hypotension and liver dysfunction after the inhalation anesthesia, but these symptoms were improved by decreasing the concentration of isoflurane. Isoflurane inhalation therapy seemed useful for intractable status asthmaticus, and earlier introduction of this therapy is expected to achieve a greater therapeutic effect.

Administration, Inhalation↗
PubMed1986

Preliminary observation of impaired water excretion in treated status asthmaticus.

Patients in status asthmaticus often have elevated plasma antidiuretic hormone levels. To determine if children in status asthmaticus have impaired water excretion and an increased risk of developing significant hyponatremia when given a fluid challenge, five consecutive patients who showed moderate asthmatic symptoms after taking two doses of epinephrine hydrochloride were given a fluid challenge (20 mL/kg of 5% dextrose in 0.2% normal saline solution given intravenously over 30 minutes followed by maintenance fluids [1,500 mL/sq m/24 hr] for 50 minutes). Urine was collected at 20-minute intervals for measurement of free-water clearance and percent water-load excretion in 80 minutes. This protocol was repeated 24 to 48 hours later, after clinical improvement. None of the patients was hyponatremic during status asthmaticus before water loading. However, four of five patients were mildly hyponatremic (serum sodium level between 130 and 132 mEq/L) between status asthmaticus and after clinical improvement. These same four patients also became mildly hyponatremic after fluid challenge during status asthmaticus. Maximal free-water clearance and percent water load excretion in 80 minutes were significantly lower during status asthmaticus after fluid challenge compared with results obtained after water loading when the patients' conditions were clinically improved. We conclude that patients in status asthmaticus have impaired water excretion after water loading but with a small risk of significant hyponatremia; a patient remaining in status asthmaticus and given large volumes of hypotonic fluid over a prolonged period of time may be at higher risk for significant hyponatremia.

Adolescent↗
PubMed1993

High-dose intravenous magnesium sulfate in the management of life-threatening status asthmaticus.

In severe status asthmaticus basic medical treatment often fails to improve the patient's condition. Mechanical ventilation in this situation is associated with a high incidence of serious complications. After the bronchodilating effect of moderate-dose magnesium sulfate in asthmatic patients had been demonstrated in previous studies we treated five mechanically ventilated patients with refractory status asthmaticus successfully with high dosages of MgSO4 IV (10-20 g within 1 h depending on the bronchodilating effect). MgSO4 resulted in a significant decrease of peak airway pressure (43.0 +/- 6.8 to 32.0 +/- 8.0 cmH2O) and inspiratory flow resistance (22.7 +/- 7.0 to 11.9 +/- 6.0 cmH2O.l-1.s-1) within 1 h. The resulting serum magnesium levels after one hour were up to threefold of the normal serum levels. Although a maintainance dose of 0.4 g/h had been administered continuously during the following 24 h serum magnesium decreased towards normal values within this time. The only relevant side-effect was a mild to moderate arterial hypotension in two of the five patients during the high dose administration period of MgSO4 which responded readily to dopamine treatment.

Adult↗
PubMed1994

Treatment of critical status asthmaticus in children.

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.

Adolescent↗
PubMed1979

The role of mesna in the treatment of status asthmaticus in children.

Status asthmaticus in children is a life-threatening condition that calls for a comprehensive set of therapeutic measures, viz. evacuation of tracheobronchial secretions, parenteral drug administration and improvement of alveolar gas exchange. In the authors' experience, that therapeutic procedure can be much improved by bronchial lavage with mesna. This is illustrated by the good results obtained in fourteen patients with status asthmaticus and in another forty-four cases of global respiratory insufficiency. Evaluation was by blood gas values and X-ray pictures. The method used for bronchial lavage is described.

Adolescent↗
PubMed1991

Status asthmaticus: an overview.

Status asthmaticus (SA) is a life-threatening exacerbation of asthma that is refractory to usual therapeutic interventions. The etiologic factors leading to SA and pathophysiologic alterations in airway caliber, respiratory muscle function, and respiratory gas exchange are reviewed. Important parameters in the assessment of patients presenting with SA are highlighted, including the necessity to document the severity of airflow obstruction with measurement of peak expiratory flow rate or one-second vital capacity. The indications for measurement of arterial blood gases, characteristic alterations in oxygen and carbon dioxide tension, and the appropriate therapeutic measures are emphasized. In addition, the roles of beta-adrenergic agonist and anticholinergic bronchodilators, methylxanthines, and glucocorticoids are discussed in the context of the rational management of patients with SA. Airway management and assisted mechanical ventilation are reviewed, with helpful guidelines for respirator adjustment based on patient responses to the physiologic alterations that develop during assisted ventilation.

Adrenal Cortex Hormones↗