Treatment Guidelines for Status Asthmaticus
5/1/06
Advocate Hope Children’s Hospital
Guidelines for Status Asthmaticus
Asthma Management Protocol
Definition
Status Asthmaticus is defined as asthma that is severe at its onset or progresses rapidly despite standard therapy; without successful management.
Indications for ICU Admission
· Severe Asthma
· Continuous nebulization of B-adrenergic agents
· FiO2 > 40%
· FEV1< 20%
· Change in conscious and/or obvious exhaustion
· Cyanosis
· Pneumothorax
· Respiratory arrest and/or cardiac arrest
· Mechanical ventilation
Stepwise Management
Clinical Asthma Score
Assess on admission, then every hour. If no improvement in three hours, move to the next stage.
Step 1
The Standard Stage
· 100 % Oxygen
· Continuous nebulized bronchodilator:
Either Albuterol 0.5 mg/Kg/hr, maximum 20 mg/hr
Or Xopenex (Levalbuterol) 0.25 mg/Kg/hr, maximum 10 mg/hr
· Atrovent (Ipratropium Bromide) Nebs:
500 mcg/dose (1 unit) every 2 hours for children > 1 year
250 mcg/dose for infants
· Solumedrol (Methylprednisolone) I.V.
Load 2 mg/Kg
Then after 6 hours start with 1-2 mg/Kg/dose every 6 hours
Step 2
The Initial Rescue Stage
· Terbutaline I.V. (Load dose):
10 mcg/Kg one dose over 20 minutes
The Critical Rescue Stage
· Terbutaline I.V. Drip: Follow Terbutaline Guidelines
Start at 0.4 mcg/Kg/min
Increase by 0.1 mcg/Kg min q/30 min to effect
Max. 4 mcg/Kg/min or development of side effects
Re-bolus with each increase if necessary
If no improvement go to Step 3
Step 3
· MgSo4 Magnesium Sulfate I.V. (Load dose):
25 - 75 mg/Kg one dose over 30 minutes (avoid faster infusions due to muscle relaxant effect and hypotension).
· Aminophylline I.V. (Load dose):
6 mg/Kg one dose over 30 minutes, then draw a level 30 minutes after infusion, therapeutic 10 - 20 mcg/ml.
· MgSo4 I.V. repeated doses; keep serum magnesium level between 3 and 5 to be effective.
· Aminophylline I.V. Drip: Follow Aminophylline Guidelines
0.5 to 1.2 mg/Kg/hr
(The dose should be started according to the patient’s age)
Step 4
The Non-Invasive Ventilatory Stage
CPAP/PS
Start with 5 cmH2O and increase as needed
BiPAP
Start with iPAP of 10 cmH2O and ePAP of 4 cmH2O
Increase pressure levels as needed if tolerated
| Attachment | Size |
|---|---|
| Status Asthmaticus | 83.5 KB |