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Paediatric Medicine

Status Asthmaticus

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

Clinical features

Too breathless to talk

  • Too breathless to feed
  • Respiratory rate >50/min
  • Pulsus paradoxus >20 mm of Hg
  • PEFR 140/min
  • Fatigue/exhaustion
  • Agitation or reduced level of consciousness
  • Inaudible breath sounds
  • O2 saturation 40 mm of Hg
  • Severe chest retraction.

Management

The patient should be admitted to a hospital preferably in an ICU where the condition can be monitored. Ideal management of status asthmaticus requires facilities for blood gas analysis, estimation of serum electrolytes, estimation of blood theophylline level, etc. Under our set up, the following management can be followed:

  1. O2 administration by nasal catheter or mask if tolerated by the patient at 3-4 lit/min.
  2. Nebulisation: 5 mg or 2.5 mg for younger children, of salbutamol or 10 mg or 5 mg of Terbutaline.
  3. IV Hydrocortisone 50-100 mg IV 6th hrly.
  4. If life-threatening features are present, IV Aminophylline 5 mg/kg/dose in 20 min to start with, followed by same dose 6th hrly.
  5. Ipratropium bromide 250 μg/kg can be added to the βagonist nebuliser, for younger children 6th hrly.
  6. IV fluid Isolyte-P or 5% Dextrose one and half times of the maintenance to be started immediately after hospitalisation (because of the presence of SIADH excess fluids to be avoided).
  7. If response is poor in 1 hour, IV beta-agonist 0.4–0.6 μg/ kg/mts. Continuous infusion to start with. Increase by 0.2 μg/kg/min to a maximum 3-6 μg/kg/min.
  8. Intermittent positive pressure ventilation (IPPB) with help of an anaesthetist as a last resort in some cases which fail to respond.