Intensive Care Management of Pediatric Status Asthmaticus

Background: Status asthmaticus (SA) in children and adolescents is a medical emergency that requires immediate specialized care in an intensive care unit.

Objective: To determine the current state of the problem regarding etiopathogenesis, diagnosis, and intensive care management of pediatric SA.

Materials and methods: We searched keywords (status asthmaticus, children and adolescents, glucocorticoids, intensive care, mechanical ventilation) in the Cochrane Library, PubMed, and Medscape and analyzed the found papers. We selected 42 sources for the review. The inclusion criterion was the description of the pathogenesis, clinical manifestations, and intensive care features in children and adolescents with SA. The exclusion criterion was the information on etiopathogenesis, clinical manifestations, and emergency care in adults and older adults with SA.

Results: Glucocorticoids and β₂-agonists are the first line of therapy in SA. Oxygen therapy, including high-flow oxygen delivery and noninvasive positive pressure ventilation, is critical in pediatric cases. The second-line treatment includes methylxanthines, anticholinergic drugs, and magnesium sulfate. In case of drug treatment failure, children are intubated and placed on mechanical ventilation.

Conclusions: Pediatric SA is a medical emergency with a high mortality risk, requiring competent emergency care. Knowledge of step-by-step intensive therapy will improve the management of this condition in children and adolescents.

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