A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children

@article{Wong2014ARO,
  title={A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children},
  author={Judith Ju-Ming Wong and Jan Hau Lee and David A. Turner and Kyle J. Rehder},
  journal={Expert Review of Respiratory Medicine},
  year={2014},
  volume={8},
  pages={423 - 441}
}
Asthma is a common and potentially life threatening childhood condition. Asthma involves not only chronic airway remodeling, but may also include frequent exacerbations resulting from bronchospasm, edema, and mucus production. In children with severe exacerbations, standard therapy with β2-agonists, anti-cholinergic agents, oxygen, and systemic steroids may fail to reverse the severe airflow obstruction and necessitate use of adjunctive therapies. These therapies include intravenous or inhaled… 
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References

SHOWING 1-10 OF 119 REFERENCES
Use of ketamine in asthmatic children to treat respiratory failure refractory to conventional therapy
TLDR
Ketamine should only be used for asthmatics whose respiratory failure does not respond to conventional management and mechanical ventilation, and except for increased secretions during the infusion, patients showed no immediate or long-term sequelae from ketamine therapy.
Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy.
TLDR
Severe asthmatic cases may benefit from magnesium sulphate therapy when beta-2 agonists are inadequate in preventing deterioration, according to this randomized, double-blind, placebo-controlled clinical trial.
Inhaled magnesium sulfate in the treatment of acute asthma.
TLDR
Nebulised inhaled magnesium sulfate in addition to beta2-agonist in the treatment of an acute asthma exacerbation, appears to have benefits with respect to improved pulmonary function and there is a trend towards benefit in hospital admission.
Intravenous beta(2)-agonists versus intravenous aminophylline for acute asthma.
TLDR
The benefit of IV beta(2)-agonists versus IV aminophylline for acute asthma treated in the emergency department and in patients admitted to hospital with acute severe asthma is compared.
Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators.
TLDR
In children with a severe asthma exacerbation, the addition of intravenous aminophylline to beta2-agonists and glucocorticoids (with or without anticholinergics) improves lung function within 6 hours of treatment, however there is no apparent reduction in symptoms, number of nebulised treatment and length of hospital stay.
A randomized trial of magnesium in the emergency department treatment of children with asthma.
TLDR
The routine administration of high-dose magnesium to moderate to severely ill children with asthma, as an adjunct to initial treatment with albuterol and corticosteroids, was not efficacious.
Extracorporeal life support for status asthmaticus: the breath of life that's often forgotten
TLDR
The use of ECLS for status asthmaticus, as reported through the Extracorporeal Life Support Organization, is briefly overviewed, including the specific institutional experience at Children's Healthcare of Atlanta at Egleston, and how earlier initiation of EFLS may benefit patients with severe status ast hmaticus refractory to conventional medical therapy is considered.
Effectiveness of magnesium sulfate as initial treatment of acute severe asthma in children, conducted in a tertiary-level university hospital: a randomized, controlled trial.
TLDR
Intravenous infusion of magnesium sulfate during the first hour of hospitalization in patients with acute severe asthma significantly reduced the percentage of children who required mechanical ventilation support.
A randomized controlled trial of intravenous magnesium sulphate as an adjunct to standard therapy in acute severe asthma.
TLDR
I MgSO4 improves pulmonary function and discharge rates, when used as an adjunct to standard therapy in patients with severe exacerbation of asthma, and could cause improvement inmonary function and decrease in hospital admission.
...
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