Artikel
Treatment of Acute Asthma in Children: A Clinical Practice Guideline from the Alexandria University Hospitals, Center for Evidence-Based Clinical Practice Guidelines, Healthcare Quality Directorate and the Alexandria Faculty of Medicine, Department of Pediatrics, Pediatric Respiratory, Allergy & Immunology Unit and Alexandria University Children's Hospital
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Veröffentlicht: | 10. Juli 2012 |
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Description: Adaptation of 3 source CPGs for clinicians managing acute asthma in children in PEDs.
Methods: Part1: cross-sectional study (questionnaire survey) for needs assessment of current practice in selected healthcare settings to select topic and justify need for thisCPGs.
Part2: Adaptation (ADAPTE Process).
Recomm.I-1: Children with life threatening asthma/SpO2 <90% receive urgently high flow O2. Recomm.I-2-a: Inhal. β2-agonists are 1st line treatment for acute asthma. Recomm.I-2-b: pMDI+ spacer is preferred in mild-moderate asthma. Recomm.I-2-c: Individualize drug dosing according to severity and response. Recomm.I-2-d: Children with acute asthma in primary care not improved after 10 puffs β2-agonists should be referred to hospital. Recomm.I-2-e: Treat children during transport to hospital by ambulance with O2+nebul. β2-agonists. Recomm.I-2-f: Transfer children with severe-life threatening asthma urgently to hospital to receive nebul. β2-agonists. Recomm.I-2-g: Oral β2-agonists are not recommended for acute asthma. Recomm.I-2-h: For mild-moderate acute asthma, a pMDI+spacer is optimal device. Recomm.I-3-a: If refractory to initial β2-agonist, add ipratropium. Recomm.I-3-b: Repeated doses of ipratropium given early to children poorly responsive to β2-agonists. Recomm.I-3-c: Consider inhaled ipratropium+inhaled β2-agonist for more severe symptoms. Recomm.I-4-a: Prednisolone early in treatment of acute asthma. Recomm.I-4-b: Dose of prednisolone age-dependent. Recomm.I-4-c: Consider steroid tablets in infants early in managing moderate-severe acute asthma in hospitals. Recomm.I-4-d: Steroid tablet therapy is preferred steroid for use. Recomm.I-4-e: Do not initiate inhaled steroids in preference to steroid ablets in acute asthma. Recomm.II-1-a: Consider early single dose of IV salbutamol in severe cases not responding to initial inhaled therapy. Recomm.II-1-b: when inserting IV cannula take sample for serum electrolytes. Recomm.II-2-a: Aminophylline not recommended in mild/moderate acute asthma. Recomm.II-2-b: Consider aminophylline in HDU/PICU for severe/life threatening bronchospasm unresponsive to max. doses of β2-agonists+steroids. Recomm.II-3: IV Magnesium sulphate is safe for acute asthma. Recomm.II-4: ECG monitoring for all IV treatments.