University of Mississippi Medical Center, Jackson, MS, USA.
University of Louisville, Louisville, KY, USA.
J Extra Corpor Technol. 2024 Sep;56(3):114-119. doi: 10.1051/ject/2024008. Epub 2024 Sep 20.
In the state of Kentucky, many status asthmaticus (SA) patients require care in the Pediatric Intensive Care Unit (PICU) and a fraction of these patients may receive "rescue therapies" with inhaled volatile anesthetics (IVA) and/or Extracorporeal Membrane Oxygenation (ECMO). We present a series of such patients with the objective of comparing the clinical parameters of individual patients who received inhaled volatile anesthesia and subsequently the need for ECMO.
Children between 2 and 18 years of age admitted to our PICU from January 2014 to July 2020 with SA were reviewed and categorized as 1) patients who received IVA alone, 2) patients who received IVA and then subsequently ECMO, and 3) patients on ECMO alone.
A total of 1772 children with SA episodes were identified with a mortality of 13 patients. Seven children with SA were identified who received either IVA, ECMO, or both. One patient received only IVA, 5 received both IVA and ECMO and one received only ECMO. All received standard asthma therapies of steroids, albuterol, magnesium sulphate, and aminophylline prior to escalation. Six out of seven refractory SA received IVA, and five (83%) of those were subsequently escalated to ECMO. There was an improvement in mean pH after cannulation compared to IVA. pCO levels had no improvement after IVA administration but decreased by an average of 20 points after ECMO. Patients peak inspiratory pressures decreased within the 1st 24 h of ECMO cannulation from a mean of 30 to 18. There were no other complications related to ECMO placement.
While we cannot decisively draw any conclusions from our study due to the small sample, it was noted that there was no clear advantage of using IVA prior to ECMO in our patients. Most patients who received IVA were escalated to ECMO indicating that early ECMO cannulation may be beneficial. Given the high cost and potential complications of both, there is a need for the development of well-defined guidelines for severe SA management in the PICU.
在肯塔基州，许多哮喘持续状态（SA）患者需要在儿科重症监护病房（PICU）接受治疗，其中一部分患者可能会接受吸入挥发性麻醉剂（IVA）和/或体外膜氧合（ECMO）的“抢救治疗”。我们介绍了一系列这样的患者，目的是比较接受吸入挥发性麻醉后和随后需要 ECMO 的患者的临床参数。
对 2014 年 1 月至 2020 年 7 月期间因 SA 入住我院 PICU 的 2 至 18 岁儿童进行回顾性分析，并分为以下三类：1）仅接受 IVA 治疗的患者，2）先接受 IVA 治疗后再接受 ECMO 治疗的患者，3）仅接受 ECMO 治疗的患者。
共确定 1772 例 SA 发作患儿，死亡率为 13 例。发现 7 例 SA 患儿接受了 IVA、ECMO 或两者联合治疗。1 例患儿仅接受 IVA，5 例患儿同时接受 IVA 和 ECMO，1 例患儿仅接受 ECMO。所有患儿在升级治疗前均接受了类固醇、沙丁胺醇、硫酸镁和氨茶碱等标准哮喘治疗。7 例难治性 SA 患儿中有 6 例接受了 IVA，其中 5 例（83%）随后升级为 ECMO。与 IVA 相比，插管后平均 pH 值有所改善。IV A 给药后 pCO2 水平无改善，但 ECMO 后平均降低 20 个点。ECMO 插管后 24 小时内，患者吸气峰压从平均 30 降至 18。ECMO 置管无其他并发症。
由于样本量小，我们无法从研究中得出明确的结论，但值得注意的是，在我们的患者中，在使用 ECMO 之前使用 IVA 并没有明显的优势。大多数接受 IVA 的患者都升级为 ECMO，这表明早期 ECMO 插管可能有益。鉴于两者的高成本和潜在并发症，需要为 PICU 中严重 SA 的管理制定明确的指南。
