Outcomes of children with life-threatening status asthmaticus requiring isoflurane therapy and extracorporeal life support.
Outcomes of children with life-threatening status asthmaticus requiring isoflurane therapy and extracorporeal life support.
复制标题
需要异氟烷治疗和体外生命支持的危及生命的哮喘持续状态儿童的结果。
DOI：
10.1080/02770903.2023.2191715
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Grunwell,JocelynR
中科院分区：
文献类型：
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作者：
Kolli,Sneha;Opolka,Cydney;Westbrook,Adrianna;Gillespie,Scott;Mason,Carrie;Truitt,Brittany;Kamat,Pradip;Fitzpatrick,Anne;Grunwell,JocelynR
背景严重的难治性哮喘是一种危及生命的紧急情况，可以用异氟烷和体外生命支持来治疗。本研究的目的是描述接受异氟醚和/或体外生命支持治疗近乎致命性哮喘的儿童对异氟醚的临床反应和出院后的结果。方法这是一项回顾性描述性研究，使用来自佐治亚州亚特兰大单一医疗系统内两个儿科重症监护病房的电子病历数据。结果45 名儿童接受了异氟醚，14 名儿童接受了体外生命支持，其中 9 名儿童未进行异氟醚试验。高碳酸血症和酸中毒在开始使用异氟烷后四小时内得到改善。四名儿童在因哮喘入院期间死亡。 27% 的患者从基线到出院时功能状态评分发生了 3 分或以上的变化。患者使用支气管扩张剂前和后的预测 FEV1 和 FEV1/FVC 比值的中位百分比低于正常儿科值。 结论 接受异氟烷和/或 ECLS 的儿童之前入住 PICU 和插管的频率较高。开始使用异氟烷后的前四个小时内，通气和酸中毒得到改善。需要异氟烷或 ECLS 的儿童可能会出现长期的功能状态缺陷。患有近乎致命的哮喘的儿童是高危人群，需要在 PICU 出院后一年内加强随访。
BackgroundSevere, refractory asthma is a life-threatening emergency that may be treated with isoflurane and extracorporeal life support. The objective of this study was to describe the clinical response to isoflurane and outcomes after discharge of children who received isoflurane and/or extracorporeal life-support for near-fatal asthma.MethodsThis was a retrospective descriptive study using electronic medical record data from two pediatric intensive care units within a single healthcare system in Atlanta, GA.ResultsForty-five children received isoflurane, and 14 children received extracorporeal life support, 9 without a trial of isoflurane. Hypercarbia and acidosis improved within four hours of starting isoflurane. Four children died during the index admission for asthma. Twenty-seven percent had a change in Functional Status Score of three or more points from baseline to PICU discharge. Patients had median percent predicted FEV1 and FEV1/FVC ratios pre- and post-bronchodilator values below normal pediatric values.ConclusionChildren who received isoflurane and/or ECLS had a high frequency of previous PICU admission and intubation. Improvement in ventilation and acidosis occurred within the first four hours of starting isoflurane. Children who required isoflurane or ECLS may develop long-lasting deficits in their functional status. Children with near-fatal asthma are a high-risk group and require improved follow-up in the year following PICU discharge.