Chest
Clinical Investigations in Critical CareEfficacy of IV The ophylline in Children With Severe Status Asthmaticus
Section snippets
Materials and Methods
The Institutional Review Board of St. Louis University reviewed and approved this study at Cardinal Glennon Children's Hospital. Patients were enrolled after informed consent was obtained from their parents or guardians.
Patient Characteristics
Patients were enrolled in the study from October 1995 through January 2000. During this period, 4,520 patients were admitted to the PICU, including 320 in status asthmaticus. Forty-seven children in severe status asthmaticus, representing 49 separate admissions to the PICU, qualified and were enrolled in the study. Enrolled subjects ranged in age from 13 months to 17 years of age. One patient was enrolled on three occasions (two theophylline and one control assignment). Two other children were
Discussion
This is the first prospective, randomized, controlled trial of IV theophylline limited to children admitted to the PICU and receiving standard β-agonist, anticholinergic, and steroid therapy for severe status asthmaticus. We found that theophylline hastened the improvement of our nonintubated patients and shortened their observed recovery time from 31.1 ± 4.5 to 18.6 ± 2.7 h. Theophylline was associated with a greater fall in baseline respiratory rate than was seen in control subjects,
ACKNOWLEDGMENT
The authors express appreciation to the ED attendings, pediatric housestaff, PICU nurses, and respiratory therapists for their assistance. We are grateful to Doris Rubio, PhD, for her statistical consultation. A special thanks to Drs. James Kemp and Blakeslee Noyes for their review of the article.
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Cited by (70)
Aminophylline infusion for status asthmaticus in the pediatric critical care unit setting is independently associated with increased length of stay and time for symptom improvement
2014, Pulmonary Pharmacology and TherapeuticsAsthma essentials
2013, African Journal of Emergency MedicinePediatric Status Asthmaticus
2013, Critical Care ClinicsCitation Excerpt :This is caused in part by decreased bronchodilator effectiveness compared with β-adrenergic agonists and the small therapeutic window and their unfavorable side effect profile. However, they still may have a role in select patients with refractory status asthmaticus.51,52 Inhalational anesthetics, such as halothane and isoflurane, can cause bronchodilation through smooth muscle relaxation and have been used anecdotally to treat status asthmaticus in children refractory to conventional therapies.53–55
Anaesthetic management of the child with co-existing pulmonary disease
2012, British Journal of AnaesthesiaCitation Excerpt :Because of the fact that its effect is less than that of low-dose inhaled corticosteroids, it is seldom used as first-line therapy. It has proven effective as a rescue medication in status asthmaticus.18 Because theophylline has a very low therapeutic index, serum monitoring is essential.
Fatal and near-fatal asthma in children: The critical care perspective
2012, Journal of PediatricsCitation Excerpt :In contrast, aminophylline was administered to only 4% of the children before intubation, to 17% during mechanical ventilation, and to 5% after extubation. Aminophylline has been reported to improve several important outcomes in children hospitalized with asthma (though not necessarily critical asthma) in both randomized controlled trials23-26 and a Cochrane meta-analysis.27 The reasons for this disparity in acceptance are unclear.
Common Pediatric Respiratory Emergencies
2012, Emergency Medicine Clinics of North America
Supported by Cardinal Glennon Children's Hospital.
This study was presented, in part, at the 27th Educational and Scientific Symposium of the Society of Critical Care Medicine, San Antonio, TX, February 4–8, 1998.