Çocuk Yoğun Bakım Ünitesinde Tedavi Edilen Şiddetli Astım Ataklı Hastaların Değerlendirilmesi: 8 Yıllık Tek Merkez Deneyimi

Abstract

Amaç: Bu çalışmada, Şiddetli astım atağı (ŞAA) nedeniyle üçüncü basamak çocuk yoğun bakım ünitesinde (ÇYBB) izlenen çocuk hastaların demografik ve klinik özelliklerini değerlendirmeyi ve bu hastalar için optimal yoğun bakım yönetimini tartışmayı amaçladık. Gereç ve Yöntem: 2013-2020 yılları arasında ÇYBB'de ŞAA tanısıyla izlenen 12 ay ile 18 yaşları arasında toplam 103 hastayı geriye dönük olarak inceledik. Bulgular: Solunum desteği açısından değerlendirildiğinde; hastaların 34’ünün (%33) nazal kanül yada geri soluması oksijen maskesi, 13’ünün (%12,6) yüksek akışlı nazal kanül oksijenizasyonu (YANKO), 46’ünün (%44,7) non-invaziv mekanik ventilasyon (NIMV), 10’unun (%9,7) da invaziv mekanik ventilasyonda (IMV) takip edildiği görüldü. Yıllara göre kullanılan solunum destek tedavileri değerlendirildiğinde, son yıllarda IMV kullanım oranımız, ilk yıllara göre istatistiksel olarak azalmıştı (%5.6 vs %20; sırasıyla; p<0.001). Bir (%1) hastada pnömotoraks gelişti. İzlenen 103 hastadan ölen hasta olmadı. Sonuç: Bronkodilatörler, sistemik kortikosteroidler ve gerekirse intravenöz magnezyum sülfat ile birlikte YANKO veya NIMV'in erken başlatılmasının ŞAA tedavisi için güvenli ve uygulanabilir bir tedavi seçeneği olduğunu düşünmekteyiz. ÇYBÜ’de ŞAA’da, çocuk yoğun bakım uzmanı, hastayı sistematik olarak değerlendirmeli, solunum desteği ve ek tedavi ihtiyacına hızlı bir şekilde karar vermelidir.

Keywords

• Şiddetli astım atağı
• çocuk yoğun bakım
• non-invaziv mekanik ventilasyon

Evaluation of Patients with Severe Asthma Exacerbation treated in a Pediatric Intensive Care Unit: 8 Years of Single-Center Experience

Abstract

Aim: In this study, we aimed to evaluate the demographic and clinical characteristics of pediatric patients followed in tertiary pediatric intensive care unit (PICU) due to severe asthma exacerbation (SAE) and to discuss the optimal intensive care management for these patients. Material and Method: We retrospectively analyzed a total of 103 patients between the ages of 12 months and 18 years who were followed up in the PICU with a diagnosis of SAE between 2013 and 2020. Results: On the evaluation of data in terms of respiratory support, it was observed that 34 (33%) of the patients were treated during follow-up with, nasal oxygen cannula or standard non-rebreather oxygen face mask (NC/NRB), 13 (12.6%) with high-flow nasal cannula oxygenation (HFNC), 46 (44.7%) with non-invasive mechanical ventilation (NIMV), and 10 (9.7%) with invasive mechanical ventilation (IMV). When the respiratory supports applied by years were evaluated, the rate of invasive mechanical ventilation usage decreased significantly in recent years compared to the first years (5.6% and 20%; respectively; p < 0.001). Pneumothorax developed in one (1%) patient. No patient died among 103 patients who were followed up. Conclusion: We think that early initiation of HFNC or NIMV in combination with bronchodilators, systemic corticosteroids, and if necessary, intravenous magnesium sulfate is a safe and viable treatment option for SAE treatment. In SAE cases in the PICU, the pediatric intensive care specialist should systematically evaluate the patient and quickly decide whether there is a need for respiratory support and additional treatment.

Keywords

• Severe asthma exacerbation
• pediatric intensive care
• non-invasive mechanical ventilation

References

1. Reference1 Restrepo RD, Peters J. Near-fatal asthma: Recognition and management Current Opin Pulmon Med 2008;14(1):13–23.
2. Reference2 Hon KL, Tang WS, Leung TF, Cheung KL, Ng PC. Outcome of children with life-threatening asthma necessitating pediatric intensive care. Ital J Pediatr 2010;36:47.
3. Reference3 Chiang BL, Hsieh CT, Wang LC, et al. Clinical course and outcome of children with status asthmaticus treated in a pediatric intensive care unit: A 15-year review. J Microbiol Immunol Infect 2009;42(6):488–93.
4. Reference4 Basnet S, Mander G, Andoh J, Klaska H, Verhulst S, Koirala J. Safety, efficacy, and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric patients admitted with status asthmaticus: a pilot study. Pediatr Crit Care Med. 2012; 13(4):393–8
5. Reference5 Thill PJ, McGuire JK, Baden HP, Green TP, Checchia PA. Noninvasive positive pressure ventilation in children with lower airway obstruction. Pediatr Crit Care Med. 2004;5(4):337–42
6. Reference6 Pallin M, Hew M, Naughton M. Is non-invasive ventilation safe in acute severe asthma? Respirology. 2015; 20(2):251---7
7. Reference7 Korang SK, Feinberg J, Wetterslev J, Jakobsen JC. Non-invasive positive pressure ventilation for acute asthma in children. Cochrane Database Syst Rev. 2016;9:CD012067
8. Reference8 Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment Carroll CL, Smith SR, Collins MS, Bhandari A, Schramm CM, Zucker AR. Pediatr Crit Care Med 2007;8(2):91-5

9. Reference9 Baudin F, Gagnon S, Crulli B, Proulx F, Jouvet PA, Emeriaud G. Modalities and Complications Associated With the Use of High-Flow Nasal Cannula: Experience in a Pediatric ICU. Respir Care 2016; 61(10):1305-10.
10. Reference10 Wraight TI, Ganu SS. High-flow nasal cannula use in a paediatric intensive care unit over 3 years. Crit Care Resusc. 2015;17(3):197-201.
11. Reference11 Hasan RA, Habib RH. Effects of flow rate and airleak at the nares and mouth opening on positive distending pressure delivery using commercially available high-flow nasal cannula systems: a lung model study. Pediatr Crit Care Med. 2011;12(1):e29– 33.
12. Reference12 Volsko TA, Fedor K, Amadei J, Chatburn RL. High flow through a nasal cannula and CPAP effect in a simulated infant model. Respir Care. 2011;56(12):1893–900
13. Reference13 Smith A, França UL, McManus ML. Trends in the Use of Noninvasive and Invasive Ventilation for Severe Asthma. Pediatrics. 2020;146(4):e20200534.
14. Reference14 Carroll CL, Zucker AR. The increased cost of complications in children with status asthmaticus. Pediatr Pulmonol. 2007;42(10):914–9
15. Reference15 Johnson MD. In Search of Evidence for Using Noninvasive Ventilation for Severe Acute Asthma. Pediatrics. 2020;146(4):e2020022103.
16. Reference16 Pallin M, Naughton MT. Noninvasive ventilation in acute asthma. J Crit Care. 2014;29(4):586-93.
17. Reference17 Gupta D, Nath A, Agarwal R, Behera D. A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care. 2010;55(5):536-43
18. Reference18 Sheikh S, Khan N, Ryan-Wenger NA, Mccoy KS. Demographics, Clinical Course, and Outcomes of Children with Status Asthmaticus Treated in a Pediatric Intensive Care Unit: 8-Year Review Journal of Asthma, 2013;50(4):364-9
19. Reference19 Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in admissions for pediatric status asthmaticus in New Jersey over a 15-year period. Pediatrics 2010;126(4):e904–1.
20. Reference20 Kwofie K, Wolfson AB. Intravenous Magnesium Sulfate for Acute Asthma Exacerbation in Children and Adults. Am Fam Physician 2021;103(4):245-6.
21. Reference21 Mittal V, Hall M, Antoon J, et al. Trends in Intravenous Magnesium Use and Outcomes for Status Asthmaticus in Children's Hospitals from 2010 to 2017.J Hosp Med 2020;15(7):403-6.
22. Reference22 Aniapravan R, Pullattayil A, Ansari KA, Powell CVE. Question 5: Magnesium Sulphate for Acute Asthma in children. Paediatr Respir Rev 2020;36:112-7.
23. Reference23 Triasih R, Duke T, Robertson CF. Outcomes following admission to intensive care for asthma. Arch Dis Child 2011;96(8):729–34
24. Reference24 Mehta RM, Pearson-Shaver AL, Wheeler DS: Acute Rhabdomyolysis Complicating Status Asthmaticus in Children: Case Series and Review. Pediatr Emerg Care 2006;22(8):587-91
25. Reference25 Roberts JS, Bratton SL, Brogan TV. Acute severe asthma: Differences in therapies and outcomes among pediatric intensive care units. Crit Care Med 2002;30(3):581–5
26. Reference26 Global initiative for asthma. Global Strategy for Asthma Management and Prevention 2021. Available from: www.ginasthma.org