Management of Status Asthmaticus

Status asthmaticus is a severe, life-threatening asthma exacerbation unresponsive to standard treatments. Aggressive management is necessary to prevent respiratory failure.

1. Initial Assessment and Supportive Care

Airway, Breathing, Circulation (ABC): Assess and support airway, breathing, and circulation.
Vital Signs: Monitor respiratory rate, oxygen saturation, and peak expiratory flow rate (PEFR).
IV Access: Establish for fluid and medication administration.
Positioning: Place patient in an upright or semi-upright position.

2. Oxygen Therapy

Administer supplemental oxygen to maintain oxygen saturation (SpO₂ ≥ 92%, 94-98% in children) using a mask or nasal cannula.

3. Pharmacologic Treatment

Short-acting β₂-agonists (SABA)

Albuterol: Nebulized albuterol (2.5–5 mg every 20 minutes for the first hour), with continuous nebulization (10–15 mg/hr) if needed.

Anticholinergic Agents

Ipratropium bromide: Given with albuterol for enhanced bronchodilation (500 mcg every 20 minutes for three doses).

Systemic Corticosteroids

Methylprednisolone: IV 1–2 mg/kg or Prednisolone (40–80 mg/day) for inflammation control.

Magnesium Sulfate

For severe cases: 1–2 grams IV over 20 minutes to help bronchodilation.

Epinephrine

For severe respiratory distress: Epinephrine 0.3–0.5 mg IM may be used.

4. Other Supportive Interventions

Hydration: Ensure IV hydration to prevent dehydration.
Heliox Therapy: Considered to reduce work of breathing in severe cases.
Non-Invasive Positive Pressure Ventilation (NIPPV): Consider BiPAP for respiratory distress if the airway can be protected.

5. Mechanical Ventilation

Indicated if signs of respiratory failure occur. Ensure prolonged expiratory times to prevent dynamic hyperinflation on the ventilator.

6. Monitoring and Reassessment

Regular reassessment of respiratory status, blood gases, and clinical response to treatment is essential. Adjust treatment as needed based on patient response.

7. Additional Measures

Ketamine: Consider in intubated patients due to bronchodilatory properties.
Antibiotics: Only indicated if there is a suspected bacterial infection.

8. Disposition

Patients require close monitoring in an ICU due to risk of relapse. Long-term asthma control strategies should be reviewed post-stabilization.

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