THÔNG TIN TÀI LIỆU
Noninvasive ventilatory support (CPAP or BiPAP) may benefit patients tiring from increased work of breathing and with impending respiratory failure Pediatric studies are limited but suggest that it is generally well tolerated While some studies suggest that it may reduce need for ICU admission, in practice, most patients who require noninvasive ventilatory support are treated in an ICU setting CXRs are not routinely indicated for acute asthma exacerbations in children Wheezing is a common symptom of asthma and pneumonia in children, therefore determining which patients warrant imaging can be challenging Data regarding children of all ages with wheezing and fever who had CXR for possible pneumonia, suggest that approximately 5% will have radiographic findings of pneumonia However, the potential risks of CXR include radiation exposure and false-positive results leading to unnecessary antibiotic therapy In general, patients with a typical asthma exacerbation not routinely need imaging given this low rate of abnormal findings In a patient with mild to moderate respiratory distress, the decision to perform a CXR may be deferred until reassessment after initial treatment; focal abnormal breath sounds may have improved suggesting atelectasis as opposed to pneumonia Clinical Indications for Discharge or Admission In general, children requiring frequent albuterol (generally defined as more frequent than every to hours) or having persistent hypoxemia require admission Other reasons for admission include significant dehydration, infection requiring inpatient treatment or monitoring, or medical history that may impact the respiratory system (e.g., cardiac disease, neuromuscular disorder, or metabolic disorder) Most patients requiring frequent inhaled bronchodilator therapy or adjunctive therapy (e.g., parenteral bronchodilators) will require hospitalization Protocols regarding which therapies require an ICU setting vary by institution Patients discharged should be encouraged to follow up with their primary care providers (PCPs) within to days Discharge instructions should include information about care following the acute visit and may include formulation of an asthma action plan This provides an opportunity to assist patients with management during future exacerbations and to encourage partnership with PCPs for ongoing discussions and modifications of asthma care Inhaled steroids should be continued for patients currently taking them, and clinicians should strongly consider prescribing them from the ED when indicated Patients with or more days/nights of symptoms and/or albuterol use per week likely have chronic asthma severity in the “persistent” range and inhaled steroids are recommended Data suggest that many patients treated for acute asthma in
Ngày đăng: 22/10/2022, 13:34
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