Asthma In Emergency Room Research Articles

Right timing of mechanical ventilation in patients with bronchial asthma in emergency room

Objective To explore the right timing of mechanical ventilation in patients with bronchial asthma in emergency room. Methods A total of 67 patients with bronchial asthma undergoing mechanical ventilation were admitted into our Emergency Intensive Care Unit (EICU) from January 2010 to December 2012. According to PaCO2 before intubation, they were divided into 3 groups of low levels of PaCO2[PaCO2≤35 mmHg (1 mmHg=0.133 kPa)](n=19), normal PaCO2 (35 mmHg<PaCO2<45 mmHg)(n=21)and high PaCO2 (PaCO2 ≥45 mmHg)(n=27). Their clinical data were retrospectively analyzed. Results The in-hospital mortality of three groups were 5.3%(1/19), 9.5%(2/21) and 14.8%(4/27) and the difference was not statistically significant (χ2=1.16, P>0.05). However the average duration of mechanical ventilation of three groups were (5.6±1.7), (8.3±2.1) and (13.5±3.6) days and the difference was statistically significant (F=3.36, P=0.042). The average ICU treatment time was (7.4±2.1), (11.5±3.3) and (16.4±3.5) days and the difference was statistically significant (F=3.23, P=0.047). PaCO2 levels before intubation was positively correlated with the duration of mechanical ventilation and the ICU treatment time (r2=0.366, 0.316, P=0.031, 0.029). Conclusion The patients with bronchial asthma undergoing intubation in right time in emergency room will affect the duration of mechanical ventilation and ICU treatment time. Key words: Bronchial asthma; Mechanical ventilation; Prognosis

Effects of nebulized high‐dose budesonide on moderate‐to‐severe acute exacerbation of asthma in children: A randomized, double‐blind, placebo‐controlled study

The efficacy of inhaled corticosteroids (ICS) in asthma exacerbation are yet to be clarified. The aim of this study was to investigate the efficacy of nebulized ICS in children with moderate-to-severe acute exacerbation of asthma in an emergency room setting in order to elucidate the potential use of ICS as the first-line therapy in the management of acute exacerbation of asthma. This was a prospective, randomized, double-blind, placebo-controlled study. Paediatric patients with moderate-to-severe acute exacerbation of asthma in emergency room were randomized to receive nebulized salbutamol and ipratropium bromide, with the addition of nebulized high-dose budesonide (BUD group, n = 60) or normal saline (control group, n = 58), three doses in the first hour. The improvement in forced expiratory volume in 1 s was similar in both groups at 0 h after three doses of nebulization, but there was significantly further improvement at 1 and 2 h in the BUD group (0.095 ± 0.062 L and 0.100 ± 0.120 L, respectively) compared with the control group (0.059 ± 0.082 L and 0.021 ± 0.128 L, respectively), P = 0.013 and 0.001, respectively. Complete remission rate was significantly higher (84.7% vs 46.3%, P = 0.004) and need for oral corticosteroids was significantly lower (16.9% vs 46.3%, P = 0.011) in BUD group than in control group. On the basis of nebulized short-acting bronchodilators, addition of nebulized high-dose budesonide resulted in clinical improvement in children with moderate-to-severe acute exacerbation of asthma, suggesting that nebulized high-dose ICS can be used as first-line therapy for non-life-threatening acute exacerbation of asthma in children.