Abstract
Studies of the arterial blood gas tensions and pH in 21 children during 24 acute attacks of asthma showed that all were hypoxic on admission to hospital, and in 10 there was evidence of carbon dioxide retention. Cyanosis, invariably present when the So2 was below 85%, and restlessness in patients breathing air were the most reliable indices of the severity of hypoxia. There were no reliable clinical guides to the Pco2 level. Conventional oxygen therapy in tents (25–40%) did not always relieve hypoxia, and in three cases the administration of oxygen at a concentration of 40% or over failed to produce a normal arterial oxygen tension. Uncontrolled oxygen therapy may aggravate respiratory acidosis, and three of our patients developed carbon dioxide narcosis while breathing oxygen. The necessity for blood gas measurements in the management of severe acute asthma in childhood is emphasized.
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Selected References
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- Ambiavagar M., Jones E. S. Resuscitation of the moribund asthmatic. Use of intermittent positive pressure ventilation, bronchial lavage and intravenous infusions. Anaesthesia. 1967 Jul;22(3):375–391. doi: 10.1111/j.1365-2044.1967.tb02760.x. [DOI] [PubMed] [Google Scholar]
- Beam L. R., Marcy J. H., Mansmann H. C., Jr Medically irreversible status asthmaticus in children. Report of three cases treated with paralysis and controlled respiration. JAMA. 1965 Nov 29;194(9):968–972. doi: 10.1001/jama.194.9.968. [DOI] [PubMed] [Google Scholar]
- Downes J. J., Wood D. W., Striker T. W., Lecks H. I. Diagnosis and treatment: advances in the management of status asthmaticus in children. Pediatrics. 1966 Aug;38(2):286–290. [PubMed] [Google Scholar]
- FELDMAN R. Recognition and treatment of potentially. Ann Intern Med. 1962 Jul;57:29–33. doi: 10.7326/0003-4819-57-1-29. [DOI] [PubMed] [Google Scholar]
- KATSAROS B., LOESCHCKE H. H., LERCHE D., SCHOENTHAL H., HAHN N. [Effect of bicarbonate alkalosis on pulmonary ventilation in man. Determination of the partial effects of pH and CO2 pressure on the ventilation and comparison with the results in acidosis]. Pflugers Arch Gesamte Physiol Menschen Tiere. 1960;271:732–747. [PubMed] [Google Scholar]
- KRAEPELIEN S., ENGSTROM I., KARLBERG P. Respiratory studies in children. II. Lung volumes in symptom-free asthmatic children, 6-14 years of age. Acta Paediatr. 1958 Jul;47(4):399–411. doi: 10.1111/j.1651-2227.1958.tb07652.x. [DOI] [PubMed] [Google Scholar]
- Kelman G. R., Nunn J. F. Nomograms for correction of blood Po2, Pco2, pH, and base excess for time and temperature. J Appl Physiol. 1966 Sep;21(5):1484–1490. doi: 10.1152/jappl.1966.21.5.1484. [DOI] [PubMed] [Google Scholar]
- LANOFF G., CRAWFORD O. FATALITIES FROM BRONCHIAL ASTHMA IN CHILDREN. Ann Allergy. 1964 Jul;22:349–356. [PubMed] [Google Scholar]
- LEDBETTER M. K., BRUCK E., FARHI L. E. PERFUSION OF THE UNDERVENTILATED COMPARTMENT OF THE LUNGS IN ASTHMATIC CHILDREN. J Clin Invest. 1964 Dec;43:2233–2240. doi: 10.1172/JCI105097. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lecks H. I., Wood D. W., Downes J. Segmental atelectasis and pulmonary shunting in acute bronchial asthma and status asthmaticus. Ann Allergy. 1965 Dec;23(12):636–640. [PubMed] [Google Scholar]
- MITHOEFER J. C., RUNSER R. H., KARETZKY M. S. THE USE OF SODIUM BICARBONATE IN THE TREATMENT OF ACUTE BRONCHIAL ASTHMA. N Engl J Med. 1965 Jun 10;272:1200–1203. doi: 10.1056/NEJM196506102722303. [DOI] [PubMed] [Google Scholar]
- Marchand P., Van Hasselt H. Last-resort treatment of status asthmaticus. Lancet. 1966 Jan 29;1(7431):227–230. doi: 10.1016/s0140-6736(66)90050-x. [DOI] [PubMed] [Google Scholar]
- NEDER G. A., Jr, DERBES V. J., CARPENTER C. L., Jr, ZISKIND M. M. DEATH IN STATUS ASTHMATICUS. ROLE OF SEDATION. Dis Chest. 1963 Sep;44:263–267. doi: 10.1378/chest.44.3.263. [DOI] [PubMed] [Google Scholar]
- NUNN J. F., BERGMAN N. A., COLEMAN A. J., CASSELLE D. C. EVALUATION OF THE SERVOMEX PARAMAGNETIC ANALYZER. Br J Anaesth. 1964 Oct;36:666–673. doi: 10.1093/bja/36.10.666. [DOI] [PubMed] [Google Scholar]
- Palmer K. N., Diament M. L. Spirometry and blood-gas tensions in bronchial asthma and chronic bronchitis. Lancet. 1967 Aug 19;2(7512):383–384. doi: 10.1016/s0140-6736(67)92005-3. [DOI] [PubMed] [Google Scholar]
- REFSUM H. E. ACID-BASE STATUS IN PATIENTS WITH CHRONIC HYPERCAPNIA AND HYPOXAEMIA. Clin Sci. 1964 Dec;27:407–415. [PubMed] [Google Scholar]
- RICHARDS W., PATRICK J. R. DEATH FROM ASTHMA IN CHILDREN. Am J Dis Child. 1965 Jul;110:4–23. doi: 10.1001/archpedi.1965.02090030010003. [DOI] [PubMed] [Google Scholar]
- SCHILLER I. W., BEALE H. D., FRANKLIN W., LOWELL F. C., HALPERIN M. H. The potential danger of oxygen therapy in severe bronchial asthma. J Allergy. 1951 Sep;22(5):423–428. doi: 10.1016/0021-8707(51)90145-1. [DOI] [PubMed] [Google Scholar]
- Severinghaus J. W. Blood gas calculator. J Appl Physiol. 1966 May;21(3):1108–1116. doi: 10.1152/jappl.1966.21.3.1108. [DOI] [PubMed] [Google Scholar]
- Simpson H., Flenley D. C. Arterial blood-gas tensions and pH in acute lower-respiratory-tract infections in infancy and childhood. Lancet. 1967 Jan 7;1(7480):7–12. doi: 10.1016/s0140-6736(67)92419-1. [DOI] [PubMed] [Google Scholar]
- Simpson H., Russell D. J. Oxygen concentrations in tents and incubators in paediatric practice. Br Med J. 1967 Oct 28;4(5573):201–203. doi: 10.1136/bmj.4.5573.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Speizer F. E., Doll R., Heaf P. Observations on recent increase in mortality from asthma. Br Med J. 1968 Feb 10;1(5588):335–339. doi: 10.1136/bmj.1.5588.335. [DOI] [PMC free article] [PubMed] [Google Scholar]
- TAUSIG D., PAPPER E. M., BARACH A. L. Contributions of anesthesiology to the management of patients with asthma. N Y State J Med. 1952 Aug 1;52(15):1893–1896. [PubMed] [Google Scholar]
- TENNEY S. M. Sympatho-adrenal stimulation by carbon dioxide and the inhibitory effect of carbonic acid on epinephrine response. Am J Physiol. 1956 Nov;187(2):341–346. doi: 10.1152/ajplegacy.1956.187.2.341. [DOI] [PubMed] [Google Scholar]
- TURIAF J., GEORGES R., BASSET G., MARLAND P. [Acid-base equilibrium and gas levels of the blood in asthma]. Rev Tuberc Pneumol (Paris) 1962 Feb-Mar;26:238–266. [PubMed] [Google Scholar]
- Tai E., Read J. Blood-gas tensions in bronchial asthma. Lancet. 1967 Mar 25;1(7491):644–646. doi: 10.1016/s0140-6736(67)92541-x. [DOI] [PubMed] [Google Scholar]
- Tsuchiya Y., Bukantz S. C. Studies on status asthmaticus in children. I. Capillary blood pH and pCO-2 in status asthmaticus. J Allergy. 1965 Nov-Dec;36(6):514–522. doi: 10.1016/0021-8707(65)90188-7. [DOI] [PubMed] [Google Scholar]
- Waddell J. A., Emerson P. A., Gunstone R. F. Hypoxia in bronchial asthma. Br Med J. 1967 May 13;2(5549):402–404. doi: 10.1136/bmj.2.5549.402. [DOI] [PMC free article] [PubMed] [Google Scholar]
