Abstract
BackgroundThe French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients.ResultsThe guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/−) and 7 a low level of evidence (GRADE 2+/−). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines.ConclusionThe conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
Highlights
One of the most frequent chronic illnesses, asthma, affects 300 million people worldwide, 30 million of them in Europe [1]
The Société française de médecine d’urgence (SFMU) and the Société de réanimation de langue française (SRLF) propose these expert guidelines on the management of severe asthma exacerbation
First area: diagnosis and elements of the diagnosis For patients with asthma exacerbation, what severity criteria in medical history and at initial physical examination are associated with an increased risk of mortality and/or intensive care admission?
Summary
First area: diagnosis and elements of the diagnosis For patients with asthma exacerbation, what severity criteria in medical history and at initial physical examination are associated with an increased risk of mortality and/or intensive care admission?. Rationale A meta-analysis of five pediatric studies demonstrated, that in children with moderate to severe asthma exacerbation, magnesium sulfate improved respiratory parameters and reduced both the rate of hospitalization and the use of mechanical ventilation [50], which confirmed the findings of a previous randomized trial [51]. R3.4—The experts suggest prevention of lung overdistension by reducing tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP), and by increasing inspiratory flow, to limit plateau pressure in mechanically ventilated adult and pediatric patients with SAE. R3.8—In the absence of compelling data in adult and pediatric patients with SAE, the experts suggest discussing with an expert center the use of extracorporeal life support—venovenous ECMO or extracorporeal CO2 removal (ECCO2R)—in the case of respiratory acidosis and/or severe hypoxemia refractory to optimal medical treatment and to well-conducted mechanical ventilation. During SAE, the benefits of treatments are much greater than the very low risk of malformation
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