sodium-bicarbonate and Status-Asthmaticus

Topics: Adrenal Cortex Hormones; Asthma; Bicarbonates; Child; Humans; Infant; Infusions, Parenteral; Isoproterenol; Oxygen Inhalation Therapy; Respiration, Artificial; Sodium Bicarbonate; Status Asthmaticus; Sympathomimetics; Theophylline

To assess the effect of administration of sodium bicarbonate on carbon dioxide levels in children with life-threatening asthma (LTA) and to evaluate the clinical effect of this treatment.. Retrospective study.. A pediatric ICU (PICU) of a tertiary care university hospital.. Seventeen children with LTA who received sodium bicarbonate.. In January 1999, a new protocol for the treatment of LTA was initiated in our institution, incorporating the use of IV sodium bicarbonate in acidotic patients (pH < 7.15) with refractory status asthmaticus. Since January 1999, sodium bicarbonate was administered to 17 patients; 5 patients received two or three doses of sodium bicarbonate. In three patients, sodium bicarbonate was administered after intubation. Intubation and mechanical ventilation were performed in five patients before admission to the PICU, and in one patient during admission. There was a significant decrease of Pco(2) after sodium bicarbonate infusion (p = 0.007). An improvement of respiratory distress in all but one patient was seen as well.. Administration of sodium bicarbonate in 17 children with LTA was associated with a significant decrease in Pco(2) and an improvement of respiratory distress. The possible benefits of sodium bicarbonate in LTA deserve further study in a controlled, prospective design.

Topics: Acidosis; Adolescent; Carbon Dioxide; Child; Female; Humans; Infusions, Intravenous; Intubation, Intratracheal; Male; Respiration, Artificial; Sodium Bicarbonate; Status Asthmaticus

Status asthmaticus with respiratory failure is a potentially fatal complication of bronchial asthma. To prevent a fatality in status asthmaticus with respiratory failure, treatment with intravenous isoproterenol or mechanical ventilation has been advocated. These interventions also have serious potential complications, however, and while continuous inhalation of beta agonists has shown promise, the optimal therapy of severe status asthmaticus remains unclear. This paper describes our experience with a treatment protocol used in status asthmaticus with respiratory failure that seeks to avoid intravenous isoproterenol or assisted ventilation.. Case series of pediatric intensive care patients with severe respiratory failure due to status asthmaticus. Six children and adolescents experienced a total of nine episodes of severe respiratory failure due to status asthmaticus.. In seven of the nine episodes the patients were managed without either intravenous isoproterenol or mechanical ventilation. Hypercarbia persisted for an average of 25 hours (range 17 to 40 hours) in these seven episodes. All subjects recovered without notable sequelae. In two episodes, clinical and blood gas deterioration led to mechanical ventilation. Ventilation was required for 112 and 42 hours, respectively, in these episodes and the patients developed either pneumothorax or pneumomediastinum during ventilation.. Using a protocol initiated in 1978 for correction of hypoxia and acidemia, many patients with severe respiratory failure from status asthmaticus can be treated without isoproterenol or mechanical ventilation. Since those treatments have significant risks, consideration should be given to this intervention before resorting to them.

Topics: Acidosis, Respiratory; Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Infusions, Intravenous; Male; Oxygen Inhalation Therapy; Sodium Bicarbonate; Status Asthmaticus