Osundwa V M, Dawod S
Department of Pediatrics, Hamad General Hospital, Doha, Qatar.
Ann Allergy. 1992 Dec;69(6):518-20.
Charts of all children with severe acute asthma admitted to the Pediatric Intensive Care unit (PICU) of this hospital between January 1987 and December 1990 were reviewed retrospectively. There were 47 admissions for life threatening asthma to the PICU over this period, representing about 2% of all acute asthma admissions to our hospital. The mean duration of symptoms in these patients before admission was 54 hours. Only 55% of the PICU admissions had received bronchodilators before coming to our hospital emergency room from where they were admitted. From arterial blood gas analysis, 57% of the patients had hypercapnia (PaCO2 > 45 mmHg). All the patients received nebulized salbutamol frequently as well as intravenous aminophylline and hydrocortisone. Mechanical ventilation was used in only 8.5% of the patients. Only two patients developed pneumothorax, neither of whom had been mechanically ventilated, but they did not require surgical intervention for drainage. There was only one death in a patient who was known to have sickle cell anemia and developed sagittal sinus thrombosis. We conclude from our series that the mortality for children with life threatening asthma admitted to PICU is very low if bronchodilators and steroids are used optimally in their management, along with judicious selection of those requiring mechanical ventilation.
回顾性分析了1987年1月至1990年12月间入住本院儿科重症监护病房（PICU）的所有重度急性哮喘患儿的病历。在此期间，有47例危及生命的哮喘患儿入住PICU，约占我院所有急性哮喘住院病例的2%。这些患者入院前症状的平均持续时间为54小时。在入住我院急诊室（他们从急诊室被收治入PICU）之前，只有55%的PICU住院患者接受过支气管扩张剂治疗。根据动脉血气分析，57%的患者存在高碳酸血症（动脉血二氧化碳分压>45 mmHg）。所有患者均频繁接受雾化沙丁胺醇治疗，以及静脉注射氨茶碱和氢化可的松。仅8.5%的患者使用了机械通气。只有两名患者发生气胸，两人均未接受机械通气，但均无需手术引流。有一名已知患有镰状细胞贫血并发生矢状窦血栓形成的患者死亡。我们从本系列病例得出结论，如果在治疗中最佳地使用支气管扩张剂和类固醇，并明智地选择需要机械通气的患者，那么入住PICU的危及生命哮喘患儿的死亡率非常低。
