Of the 72 children admitted to our Pediatric Intensive Care Unit (PICU), in a period of 12 months, with diagnosis of severe status asthmaticus, 8 consecutive nonintubated patients with impending respiratory failure and poor response to bronchodilators were evaluated after flexible bronchoscopy and bronchial lavage.MATERIALS AND METHODS: All eight patients were admitted to the PICU with status asthmaticus in severe respiratory distress, with a clinical asthma score (CAS) of 5 or more. B) All had required albuterol continuous aerosolized treatments for more than 12 hours without improvement or worsening of their clinical condition. C) All had received intravenous solumedrol 2mg/kg/dose every 6 hours and were receiving atrovent 0.2mg aerosols every 4 hours. D) Six of the 8 patients were receiving a mixture of heliox 70/30 and two were receiving O2 therapy in excess of 40% by face mask. E) All patients received flexible bronchoscopy and bronchial lavage.
All 8 patients were noted to have thick mucus plugs and/or casts of bronchial secretions removed during bronchial lavage and exhibited prompt improvement following bronchoscopy. CAS dropped to ≤ 4 in all patients immediately following bronchoscopy and heliox was discontinued in the 6 patients within 2 hours after the bronchoscopy. continuous albuterol was discontinued for all patients within 6 hours after bronchoscopy. All patients survived and no complications were noted.
Flexible fiberoptic bronchoscopy is safe, and may be an effective therapeutic tool to treat pediatric patients with severe status asthmaticus who are not responding promptly to bronchodilators.
C. Maggi, None.