Inhaled Salbutamol Plus Ipratropium in Moderate and Severe Asthma Crises in Children

Iramain, Ricardo; López‐Herce, Jesús; Coronel, Julia; Spitters, Cristopher; Guggiari, Jaime; Bogado, Norma

doi:10.3109/02770903.2011.555037

Cited by 29 publications

(19 citation statements)

References 21 publications

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“…investigated the use of nebulised IB in moderate and severe exacerbations of asthma in children and found improvements in SaO 2 , pulmonary score, hospital admissions, FEV 1 and PEF. However, when they analysed the moderate and severe groups separately, only improvements in SaO 2 and FEV 1 were sustained in the group with moderate asthma . In contrast to our study, all of the above trials examined nebulised anticholinergics rather than MDI, and two of the trials examining nebulised IB used non‐maximal doses of beta 2 ‐agonist …”

Section: Discussioncontrasting

confidence: 81%

Metered‐dose inhaler ipratropium bromide in moderate acute asthma in children: A single‐blinded randomised controlled trial

Wyatt

Borland

Doyle

et al. 2014

J Paediatrics Child Health

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Section: Discussioncontrasting

confidence: 81%

Metered‐dose inhaler ipratropium bromide in moderate acute asthma in children: A single‐blinded randomised controlled trial

Wyatt

Borland

Doyle

et al. 2014

J Paediatrics Child Health

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“…Conflicting evidence casts doubt on its efficacy alongside modern selective beta agonists(17;27). Nonetheless, it was used in only 36% of patients in our study prior to intubation and in 50% during mechanical ventilation although there was a wide range of usage (14 – 83%) at individual sites.…”

Section: Discussionmentioning

confidence: 99%

Fatal and Near-Fatal Asthma in Children: The Critical Care Perspective

Newth

Meert

Clark

et al. 2012

The Journal of Pediatrics

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Objective To characterize the clinical course, therapies, and outcomes of children with fatal and near-fatal asthma admitted to the pediatric intensive care unit (PICU). Study design Retrospective chart abstraction across the eight tertiary-care PICUs in the Collaborative Pediatric Critical Care Research Network (CPCCRN). Inclusion criteria: children (1–18 years) admitted 2005 to 2009 (inclusive) for asthma receiving ventilation (near-fatal) or died (fatal). Data collected included medications, ventilator strategies, concomitant therapies, demographics and risk variables. Results Of 261 eligible children, 33 (13%) had no previous history of asthma, 218 (84%) survived with no known complications, and 32 (12%) had complications. Eleven (4%) died, 10 having had cardiac arrest before admission. Patients intubated outside the PICU had shorter ventilation (median 25 vs. 84 hours, p<0.001). African-Americans were disproportionately represented by numbers intubated and had shorter durations of intubation. Barotrauma occurred in 15 (6%) children before admission. Pharmacological therapies were highly variable with similar outcomes. Conclusions Of children ventilated in CPCCRN PICUs, 96% survived to hospital discharge. Most children who died experienced cardiac arrest prior to admission. Intubation outside the PICU was correlated with shorter ventilation duration. The complications of barotrauma and neuromyopathy were uncommon. Practice patterns varied widely between CPCCRN sites.

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“…111,112 Although there is no significant apparent benefit with the addition of multiple doses of ipratropium to an albuterol and steroid regimen in hospitalized pediatric patients, 113,114 there is a need for specific data in the PICU population. With the high safety profile and documented beneficial effects in the ED setting, 115 we recommend its use every 6 hours in the critically ill patient owing to its potential advantages, despite not being recommended by the current National Heart, Lung, and Blood Institute asthma guidelines, until further data are obtained.…”

Section: Ipratropiummentioning

confidence: 99%

“…Atrovent 0.25 to 0.5 mg will be administered every 6 hours. 115 Peak flow measurements will be instituted along with the PAS assessment for children older than 5 years.…”

Section: Appendixmentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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Inhaled Salbutamol Plus Ipratropium in Moderate and Severe Asthma Crises in Children

Abstract: Salbutamol plus ipratropium bromide improves lung function in asthmatic children with moderate to severe asthma crises, independently of age. The effect is greater in children with severe crises, with a substantial reduction in the need for hospitalization.

Cited by 29 publications

References 21 publications

Metered‐dose inhaler ipratropium bromide in moderate acute asthma in children: A single‐blinded randomised controlled trial

Metered‐dose inhaler ipratropium bromide in moderate acute asthma in children: A single‐blinded randomised controlled trial

Fatal and Near-Fatal Asthma in Children: The Critical Care Perspective

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

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