Cases reported "Status Asthmaticus"

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1/106. Moderately severe anaphylactoid reaction to pentastarch (200/0.5) in a patient with acute severe asthma.

    The use of synthetic colloids for resuscitation and volume replacement is common in the intensive care unit. Although adverse reactions have been reported to colloid solutions, the incidence of severe reactions to the starch derivatives is low. We report a case of an anaphylactoid reaction to pentastarch (200/0.5) in a young asthmatic who received it as a fluid challenge in the intensive care unit. The pathogenesis and implications of such a reaction in an asthmatic are discussed.
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2/106. Acute myopathy after status asthmaticus: steroids, myorelaxants or carbon dioxide?

    Acute myopathy complicating treatment of status asthmaticus has been increasingly recognized since its original description in 1977. We report a case of an 11-year-old boy with severe asthma requiring mechanical ventilation. He was given high doses of parenteral steroids and neuromuscular blockade with non-depolarizing agents in order to achieve controlled hypoventilation with an ensuing hypercapnoea. He developed rhabdomyolysis with elevated creatinine kinase and renal impairment secondary to myoglobinuria. Electrophysiological studies revealed myopathic abnormalities. The aetiology for this myopathy appears to be related to therapy with parenteral steroids, muscle-relaxant agents and respiratory acidosis. patients treated with steroids and neuromuscular blocking agents should be regularly monitored for development of myopathy.
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3/106. Treatment of severe status asthmaticus with nitric oxide.

    The paper reports on a 13-year-old girl with chronic asthma who presented in acute respiratory failure following an exacerbation of her disease. nitric oxide was added to the ventilator circuit at 7 ppm and then 15 ppm after the patient failed to respond to bronchodilators and steroids. This was followed by rapid improvement in respiratory mechanics and blood gases with no adverse effects. nitric oxide appears to have a direct relaxing effect on the bronchial smooth muscle.
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4/106. Inhaled heroin-induced status asthmaticus: five cases and a review of the literature.

    We report five cases of status asthmaticus (four requiring mechanical ventilation) that were triggered by inhaled heroin and review the pertinent literature. These cases share common features of sudden and severe asthma exacerbations temporally related to heroin use, stress the importance of considering illicit drug use in like cases, and call attention to a public health issue.
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5/106. Resolution of mucus plugging and atelectasis after intratracheal rhDNase therapy in a mechanically ventilated child with refractory status asthmaticus.

    OBJECTIVE: To report the dramatic resolution of unilateral mucus plugging and atelectasis in a mechanically ventilated child with refractory status asthmaticus after intratracheal recombinant human DNase (rhDNase) therapy. DESIGN: Case report. SETTING: critical care unit. PATIENT: A 7-yr-old boy with status asthmaticus, severe respiratory failure and barotrauma unresponsive to conventional therapy. Fiberoptic bronchoscopy confirmed widespread mucus impaction of the subsegmental bronchi of the left lung without response to bronchoscopic lavage. INTERVENTIONS: Two 10-mg doses of intratracheal rhDNase were administered 8 hrs apart. MAIN RESULTS: The left-sided atelectasis resolved 3 hrs after the first dose of rhDNase. Improvements in gas exchange and tidal volumes were sustained and particularly noticeable after the second dose. The patient was successfully extubated 26 hrs after receiving the rhDNase treatment without any adverse effects. CONCLUSIONS: rhDNase should be considered as a potential therapy for refractory mucus plugging and atelectasis in intubated patients with status asthmaticus.
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6/106. life-threatening status asthmaticus treated with inhaled nitric oxide.

    Inhaled nitric oxide (NO) was administered to 5 consecutive children with life-threatening status asthmaticus who required mechanical ventilation and did not respond to maximal medical management. Four showed a >20% decrease in baseline PaCO(2) (median PaCO(2) = 154 mm Hg, range = 95 to 229 mm Hg) occurring rapidly after the administration of inhaled NO. Three children, in addition to the index case, received continuous inhaled NO therapy, ranging from 5.5 to 21.5 hours. Systemic hypotension was not observed, and the maximum methemoglobin level was 1.9%. Four children survived to hospital discharge. Although the precise mechanism of action is not known, it appears that inhaled NO merits further study and may represent a life-saving therapy in this select patient population.
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7/106. Massive left diaphragmatic separation and rupture due to coughing during an asthma exacerbation.

    We report a case of herniation of abdominal contents into the left hemithorax in a patient hospitalized with an acute exacerbation of asthma accompanied by paroxysms of coughing. There was no history of trauma. We believe this is the first reported case of diaphragmatic rupture complicating an asthma exacerbation. We review clinical features, pathophysiology, diagnosis, and treatment of diaphragmatic rupture in its most common setting, trauma, and discuss its occasional "spontaneous" occurrence.
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8/106. status asthmaticus treated by high-frequency oscillatory ventilation.

    We present a 2.5-year-old girl in severe asthma crisis who clinically deteriorated on conventional mechanical ventilation, but was successfully ventilated with high-frequency oscillatory ventilation (HFOV). Although HFOV is accepted as a technique for managing pediatric respiratory failure, its use in obstructive airway disease is generally thought to be contraindicated because of the risk of dynamic air-trapping. However, we suggest that obstructive airway disease can safely be managed with HFOV, provided certain conditions are met. These include the application of sufficiently high mean airway pressures to open and stent the airways ("an open airway strategy"), lower frequencies to overcome the greater attenuation of the oscillatory waves in the narrowed airways, permissive hypercapnia to enable reducing pressure swings as much as possible, longer expiratory times, and muscle paralysis to avoid spontaneous breathing.
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9/106. status asthmaticus: is respiratory physiotherapy necessary?

    We present the case of a four year-old girl diagnosed of moderate extrinsic asthma that in the course of an episode of asthmatic status, she presented after treatment with respiratory physiotherapy an abrupt worsening of its clinical state, with appearance of a pneumotorax that precised intensive care treatment. The use of respiratory physiotherapy is dissuaded as part of the treatment in the initial phase of acute asthma, being reserved this treatment later in the recovery phase, anytime when a component of hypersecretion exists and the intensity of the bonchoconstriction has diminished.
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10/106. Lactic acidosis in status asthmaticus : three cases and review of the literature.

    Lactic acidosis is a frequent laboratory finding in patients with severe exacerbations of asthma. The pathogenesis of lactic acidosis in asthma is not well understood, but it has been presumed, by some, to be generated by fatiguing respiratory muscles. We herein report the cases of three patients with status asthmaticus and lactic acidosis despite pharmacologic muscle relaxation. No common etiologies were found for lactic acidosis that abated after bronchospasm improved and the intensity of pharmacologic therapies was reduced. We review the literature describing lactic acidosis with asthma and discuss mechanisms by which lactic acidosis may occur in patients with status asthmaticus.
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