Corticosteroid Therapy in Critically Ill Pediatric Asthmatic Patients*

Giuliano, John S.; Faustino, E. Vincent S.; Li, Simon; Pinto, Matthew; Canarie, Michael F.; Carroll, Christopher L.

doi:10.1097/pcc.0b013e31828a7451

Cited by 13 publications

(14 citation statements)

References 13 publications

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“…However, studies have shown that asthma therapy varies among institutions [29,30], including in the PICU [31]. In our EV-D68+ cohort, albuterol, corticosteroids, magnesium, and aminophylline were commonly used, even in children without a history of asthma.…”

Section: Discussionmentioning

confidence: 86%

Severe enterovirus 68 respiratory illness in children requiring intensive care management

Schuster¹,

Miller²,

Selvarangan³

et al. 2015

Journal of Clinical Virology

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Section: Discussionmentioning

confidence: 86%

Severe enterovirus 68 respiratory illness in children requiring intensive care management

Schuster¹,

Miller²,

Selvarangan³

et al. 2015

Journal of Clinical Virology

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“…A paucity of data exists on the dosing and impact of corticosteroids on outcomes in children with status asthmaticus. According to one study, many intensivists have been reported to utilize 2–4 times higher corticosteroid dosing compared to the published guidelines for children with asthma exacerbations ( 28 ). To account for confounding variables including the cumulative prednisone equivalent dosing, logistic and linear regressions were conducted to assess the odds of MV requirement and factors associated with PICU LOS, respectively.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Prolonged Magnesium Sulfate Infusions in Children With Refractory Status Asthmaticus

et al. 2022

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ObjectivesThere is a paucity of data on the use of intravenous magnesium sulfate infusion in children with refractory status asthmaticus. The purpose of this study was to evaluate the efficacy and safety of prolonged magnesium sulfate infusion as an advanced therapy.MethodsThis is a single center retrospective study of children admitted to our pediatric intensive care unit (PICU) with status asthmaticus requiring continuous albuterol. Treatment group included patients receiving magnesium for ≥4 h and control group included those on other therapies only. Patients were matched 1:4 based on age, sex, obesity, pediatric index of mortality III and pediatric risk of mortality III scores. Primary outcomes included PICU length of stay (LOS) and mechanical ventilation (MV) requirement. Secondary outcomes included mortality, extracorporeal membrane oxygenation (ECMO) requirement, analyses of factors associated with PICU LOS and MV requirement and safety of magnesium infusion. Logistic and linear regressions were employed to determine factors associated with MV requirement and PICU LOS, respectively.ResultsTreatment and control groups included 27 and 108 patients, respectively. Median initial infusion rate was 15 mg/kg/hour, with median duration of 28 h. There was no difference in the MV requirement between the treatment and control groups [7 (25.9%) vs. 20 patients (18.5%), p = 0.39]. Median PICU LOS and ECMO use were significantly higher in treatment vs. control group [(3.63 vs. 1.09 days, p < 0.01) and (11.1 vs. 0%, p < 0.01), respectively]. No mortality difference was noted. On regression analysis, patients receiving ketamine and higher prednisone equivalent dosing had higher odds of MV requirement [OR 19.29 (95% CI 5.40–68.88), p < 0.01 and 1.099 (95% CI 1.03–1.17), p < 0.01, respectively]. Each mg/kg increase in prednisone equivalent dosing corresponded to an increase in PICU LOS by 0.13 days (95% CI 0.096–0.160, p < 0.01). Magnesium infusions were not associated with lower MV requirement or lower PICU LOS after controlling for covariates. Fourteen (51.9%) patients in the treatment group had an adverse event, hypotension being the most common.ConclusionMagnesium sulfate infusions were not associated with MV requirement, PICU LOS or mortality.

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“…Critically ill children, like adults, are exposed to many risk factors for muscle wasting [e.g., sepsis (12), hyperglycemia (143), malnutrition (144) and high dose, prolonged corticosteroid use (145)]. Factors upregulating MPB, such as starvation, immobility and burns, appear to impact the young more than adults.…”

Section: Further Research Needed For Clinical Translationmentioning

confidence: 99%

A narrative review of skeletal muscle atrophy in critically ill children: pathogenesis and chronic sequelae

Ong¹,

Lee²,

Leow³

et al. 2021

Transl Pediatr

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Muscle wasting is now recognized as a growing, debilitating problem in critically ill adults, resulting in long-term deficits in function and an impaired quality of life. Ultrasonography has demonstrated decreases in skeletal muscle size during pediatric critical illness, although variations exist. However, muscle protein turnover patterns during pediatric critical illness are unclear. Understanding muscle protein turnover during critical illness is important in guiding interventions to reduce muscle wasting. The aim of this review was to explore the possible protein synthesis and breakdown patterns in pediatric critical illness.Muscle protein turnover studies in critically ill children are lacking, with the exception of those with burn injuries. Children with burn injuries demonstrate an elevation in both muscle protein breakdown (MPB) and synthesis during critical illness. Extrapolations from animal models and whole-body protein turnover studies in children suggest that children may be more dependent on anabolic factors (e.g., nutrition and growth factors), and may experience greater muscle degradation in response to insults than adults. Yet, children, particularly the younger ones, are more responsive to anabolic agents, suggesting modifiable muscle wasting during critical illness. There is a lack of evidence for muscle wasting in critically ill children and its correlation with outcomes, possibly due to current available methods to study muscle protein turnover in children-most of which are invasive or tedious. In summary, children may experience muscle wasting during critical illness, which may be more reversible by the appropriate anabolic agents than adults. Age appears an important determinant of skeletal muscle turnover. Less invasive methods to study muscle protein turnover and associations with long-term outcome would strengthen the evidence for muscle wasting in critically ill children.

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Corticosteroid Therapy in Critically Ill Pediatric Asthmatic Patients*

Cited by 13 publications

References 13 publications

Severe enterovirus 68 respiratory illness in children requiring intensive care management

Severe enterovirus 68 respiratory illness in children requiring intensive care management

Efficacy and Safety of Prolonged Magnesium Sulfate Infusions in Children With Refractory Status Asthmaticus

A narrative review of skeletal muscle atrophy in critically ill children: pathogenesis and chronic sequelae

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