Transient Intrapulmonary Shunting in a Patient Treated With β2-Adrenergic Agonists for Status Asthmaticus

OBJECTIVES:To describe the change in the management, and outcome of children with acute severe asthma (ASA) admitted to Pediatric Intensive Care Unit (PICU) at tertiary institute, as compared to previously published report in 2003.METHODS:This is a retrospective observational study. All consecutive pediatric ASA patients who were admitted to PICU during the study period were included. The data were extracted from PICU database and medical records. The Cohort in this study (2013 Cohort) was compared with the Cohort of ASA, which was published in 2003 from the same institution (2003 Cohort).RESULTS:In comparison to previous 2003 Cohort, current Cohort (2013) revealed higher mean age (5.5 vs. 3.6 years; P ≤ 0.001), higher rate of PICU admission (20.3% vs. 3.6%; P ≤ 0.007), less patients who received maintenance inhaled steroids (43.3% vs. 62.4%; P ≤ 0.03), less patients with pH <7.3 (17.9% vs. 42.9%; P ≤ 0.001). There were more patients in 2013 Cohort who received: Inhaled Ipratropium bromide (97% vs. 68%; P ≤ 0.001), intravenous magnesium sulfate (68.2% vs. none), intravenous salbutamol (13.6% vs. 3.6%; P ≤ 0.015), and noninvasive ventilation (NIV) (35.8% vs. none) while no patients were treated with theophylline (none vs. 62.5%). The median length of stay (LOS) was 2 days while mean LOS was half a day longer in the 2013 Cohort. None of our patients required intubation, and there was no mortality.CONCLUSION:We observed slight shift toward older age, considerably increased the rate of PICU admission, increased utilization of Ipratropium bromide, magnesium sulfate, and NIV as important modalities of treatment.

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“…[ 28 ] In addition, transient intrapulmonary shunting associated with β2-agonist therapy may contribute to arterial hypoxemia. [ 29 ]…”

Section: Discussionmentioning

confidence: 99%

Asthma changes at a Pediatric Intensive Care Unit after 10 years: Observational study

Al‐Eyadhy¹,

Temsah²,

Alhaboob³

et al. 2015

Ann Thorac Med

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“…IPAVAs present pathways with 25–50 µm diameter, which allow blood flow to bypass the lung capillaries and provide a route for right-to-left embolus transmission [65]. In consequence, an embolus passing through such a shunt could reach the heart or the brain.…”

Section: Hypoxia and The Lungsmentioning

confidence: 99%

Effects of Breath-Hold Deep Diving on the Pulmonary System

Schipke¹,

Lemaître²,

Cleveland³

et al. 2019

Respiration

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This short review focuses on pulmonary injury in breath-hold (BH) divers. When practicing their extreme leisure sport, they are exposed to increased pressure on pulmonary gas volumes, hypoxia, and increased partial gas pressures. Increasing ambient pressures do present a serious problem to BH deep divers, because the semi-rigid thorax prevents the deformation required by the Boyle-Mariotte law. As a result, a negative-pressure barotrauma (lung squeeze) with acute hemoptysis is not uncommon. Respiratory maneuvers such as glossopharyngeal insufflation (GI) and glossopharyngeal exsufflation (GE) are practiced to prevent lung squeeze and to permit equalizing the paranasal sinuses and the middle ear. GI not only impairs venous return, thereby provoking hypotension and even fainting, but also produces intrathoracic pressures likely to induce pulmonary barotrauma that is speculated to induce long-term injury. GE, in turn, further increases the already negative intrapulmonary pressure, thereby favoring alveolar collapse (atelectasis). Finally, hypoxia seemingly not only induces brain injury but initiates the opening of intrapulmonary shunts. These pathways are large enough to permit transpulmonary passage of venous N₂ bubbles, making stroke-like phenomena in deep BH divers possible.

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“…b-Agonist drugs are known to often worsen gas exchange during acute asthma exacerbations in some individuals, and this phenomenon is poorly explained by worsened ventilation-perfusion mismatch owing to increased flow to poorly ventilated lung regions (10). Withdrawal of b-agonist treatment during an acute asthma exacerbation has been shown to improve oxygenation and decrease right-to-left shunting (11). It is possible that the combination of relatively increased pulmonary vascular resistance and hypoxia-or catecholamine-induced vasodilator effects on bronchial arteries may lead to intrapulmonary shunting through IBAs, with increased regional blood flow bypassing alveolar capillaries and worsening gas exchange.…”

Section: Prominent Bronchopulmonary Vascular Anastomoses In Fatal Chimentioning

confidence: 99%

“…Veterans may be a target population for LCS with higher ageadjusted incidence of lung cancer, younger age at diagnosis (7,8), and higher rates of tobacco use and other exposures (9, 10), but published data in Veterans Affairs medical centers (VAMCs) have shown mixed results (11)(12)(13)).…”

confidence: 99%