Boeschoten Shelley A, van der Crabben Ruben S, Boehmer Annemie L M, de Hoog Matthijs, Buysse Corinne M P
Department of Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands.
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, Netherlands.
Case Rep Pediatr. 2019 Sep 9;2019:5057390. doi: 10.1155/2019/5057390. eCollection 2019.
Severe acute asthma (SAA) can lead to respiratory failure and can be fatal. For rational use of intravenous (IV) bronchodilators, evidence regarding the pharmacokinetics and pharmacodynamics is lacking in children. The use of a loading dose IV salbutamol is not mentioned in any international guideline, and its use varies greatly between PICUs worldwide. We describe a 17-year-old Caucasian female with SAA resulting in an out-of-hospital cardiac arrest. After basic life support and return of spontaneous circulation, the ambulance administered oxygen, inhaled salbutamol, IV magnesium sulphate, and systemic corticosteroids. Despite of this, she was still in severe respiratory distress. Therefore, a loading dose of IV salbutamol was administered, after which an immediate improvement was observed. Having a loading dose of IV salbutamol available for emergency medical services use for SAA in children with life-threatening SAA in the out-of-hospital setting is important to consider. Further study on the dose and the effect of a loading dose IV salbutamol in children with SAA is necessary.
重度急性哮喘（SAA）可导致呼吸衰竭，甚至可能致命。关于儿童静脉使用支气管扩张剂的合理应用，目前缺乏药代动力学和药效学方面的证据。国际指南中均未提及静脉注射沙丁胺醇负荷剂量的使用，全球各儿科重症监护病房（PICU）对此的使用差异很大。我们报告一名17岁的白种女性，因SAA导致院外心脏骤停。在进行基础生命支持并恢复自主循环后，急救人员给予了氧气、吸入沙丁胺醇、静脉注射硫酸镁和全身用糖皮质激素。尽管如此，她仍处于严重的呼吸窘迫状态。因此，给予了静脉注射沙丁胺醇负荷剂量，之后观察到病情立即改善。对于院外发生危及生命的SAA的儿童，考虑为紧急医疗服务配备静脉注射沙丁胺醇负荷剂量用于治疗很重要。有必要进一步研究静脉注射沙丁胺醇负荷剂量在SAA儿童中的剂量和效果。
