Pressure-controlled ventilation in children with severe status asthmaticus*

Abstract

Based on this retrospective study, we suggest that pressure-controlled ventilation is an effective ventilatory strategy in severe status asthmaticus in children. Pressure-controlled ventilation represents a therapeutic option in the management of such children.

Pediatric Asthma

“…Both pressure-limited and volume-limited modes have been used to ventilate children with acute asthma and respiratory failure, but neither approach has been demonstrated to be more effective than the other (Sarnaik et al 2004 ;Malmstrom et al 2001 ). However, there are important advantages and disadvantages of each therapy to consider when the clinician weighs the decision about which mode to use in a particular patient.…”

“…However, there are several key themes in the ventilation of children with acute asthma and respiratory failure that are generally accepted. Controlled hypoventilation with low peak inspiratory pressures, low respiratory rates, and permissive hypercapnia is often used with the perception that this strategy improves outcomes and decreases complications (Darioli and Perret 1984 ;Sarnaik et al 2004 ). Plateau pressures of less than 30 cm H 2 O and tidal volumes of less than 8 mL/kg are suggested to reduce the potential for barotrauma (Levy et al 1998 ).…”

“…Several strategies have been proposed to achieve these goals. However, most are based on expert reviews or small retrospective cohorts (Koh 2001 ;Darioli and Perret 1984 ;Sarnaik et al 2004 ;Malmstrom et al 2001 ;Shugg et al 1990 ).…”

Diagnosis and Management of Respiratory Adverse Events in the Operating Room

“…However, in the presence of airflow obstruction (e.g., in asthmatic children), plateau pressures and even more so peak inspiratory pressures do not reliably reflect alveolar pressures and higher airway pressures can be accepted without the risk of barotrauma. Flow-time curves can aid to monitor whether expiratory flows return to baseline [79,80].…”

Guideline for the management of acute asthma in children: 2013 update

“…[61][62][63] If intubation and mechanical ventilation are required, the currently preferred mode of ventilation is pressure control or pressure support ventilation, with slower rates allowing a sufficiently long expiratory time to permit emptying of the lungs. [63,64] Ketamine is recommended for sedation in intubated patients, and inhaled anaesthetic gases may be required in very severe cases not responding to maximal other therapy. [63] 8.…”