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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review of ICU admissions for asthma to the Childrens Hospital of Los Angeles was conducted for the period January 1969 through July 1977. The admission rate remained relatively constant during this period. Patients requiring ICU admission tended to be young, intractable severe asthmatics whose asthma started at a very young age. There were three patients who had no previous history of asthma. The incidence of pneumonitis/atelectasis was somewhat greater than has been reported for patients hospitalized for status asthmaticus. A significant number of children received neither intravenous corticosteriods, sympathomimetics nor oxygen therapy while hospitalized prior to transfer to the ICU. Those children receiving mechanical ventilation or intravenous isoproterenol tended to be somewhat younger and had a higher incidence of pneumonitis/atelectasis and more abnormal blood gas determinations than their counterparts who were not similarly treated. Mechanical ventilation was administered to 15 patients and 19 patients received intravenous isoproterenol. Intravenous isoproterenol resulted in prompt improvement in most patients; except for one patient who experienced cardiac arrhythmia (reversed when the dosage was decreased), this medication was well-tolerated.
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PMID:Review of intensive care unit admissions for asthma. 44 39

A retrospective analysis of 811 patients admitted to the hospital for status asthmaticus over a nine-year period was performed. Eight patients died, and 19 required mechanical ventilation. All persons who died of status asthmaticus were in the group that required mechanical ventilation. In 12 of the patients who received ventilation, no definite cause for the acute exacerbation could be identified, although initial arterial blood gas analyses showed profound hypoxemia, hypercapnia, and acute respiratory acidosis. Seventy-eight major complications occurred during mechanical ventilation. Pneumothorax, endotracheal tube malfunction, alveolar hypoventilation on the ventilator, and pneumonia were associated with decreased survival. Mucous plugging of the airways was found in all autopsied patients. Mechanical ventilation in status asthmaticus is a life-support system associated with substantial morbidity and should be instituted only when it becomes evident that maximal medical therapy will not be efficacious.
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PMID:Status asthmaticus. A nine-year experience. 57 61

A case of Pseudomonas pneumonia developing in a patient on treatment for status asthmaticus is described. The use of broad spectrum antibiotics, high dose steroids and humidifiers or nebulizers may be of aetiological importance. Pseudomonas pneumonia is increasing in prevalence although it has not previously been described in association with status asthmaticus. It carries a high mortality and its prevention is, therefore, clearly important.
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PMID:Pseudomonas pneumonia in status asthmaticus. 60 95

One hundred asthmatic children were examined for pulsus paradoxus, a palpable diminution or obliteration of the peripheral pulse during inspiration, while in bronchospasm. Pulsus was measured with a sphygmomanometer and the difference in systolic pressure between inspiration and expiration was noted. Seventy-five children with mild asthma had no palpable pulsus and responded with complete subsidence of symptoms with one or two injections of aqueous epinephrine, 1-1000. Twenty-five children had palpable pulsus ranging from 10 mm to 30 mm. Five patients with pulsus between 10 and 15 mm were admitted to the hospital with status asthmaticus and pneumonia; eight other patients responded to parenteral epinephrine. Twelve children had pulsus of 20 mm or greater and all were hospitalized for uncomplicated status asthmaticus. Pulsus paradoxus may be found in acute exacerbation of childhood asthma and its degree correlates with both the severity and response to bronchodilating agents.
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PMID:Pulsus paradoxus in childhood asthma--its prognostic value. 86 1

A 70-year-old woman was hospitalized for status asthmaticus. The level of CRP was high and chest roentgenogram showed infiltrative shadows in the left middle lung field. Artificial respiration and continuous infusion of methylprednisolone and aminophylline 750 mg/24 hr were performed. Eight hours after admission, seizures suddenly occurred. At this time, brain CT showed no abnormal findings. The seizures were thought to be induced by theophylline toxicity, since serum theophylline concentration was high at 69.9 micrograms/ml. Because theophylline clearance of the patient in a clinically stable condition was normal, it was speculated that theophylline clearance was reduced during status asthmaticus. It is thought that this rare case of theophylline toxicity occurred due to reduction of theophylline clearance during status asthmaticus associated with pneumonia.
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PMID:[Theophylline toxicity in a patient with status asthmaticus]. 128 33

Acute respiratory failure in pregnancy is an important cause of maternal and fetal morbidity and mortality. Causes include: ARDS, venous air embolism, beta-adrenergic tocolytic therapy, asthma, thromboembolic disease, pneumothorax, and pneumomediastinum. The most common predisposing diseases for ARDS complicating pregnancy are sepsis, pneumonia, aspiration of gastric contents, and amniotic fluid embolism. Knowledge of normal maternal-fetal physiology and determinants of fetal oxygen delivery (uterine blood flow, placental transfer, fetal circulation) can help sustain normal fetal development, usually without compromising maternal care. The increased microvascular permeability seen in ARDS is likely mediated by neutrophils, proinflammatory mediators (e.g., tumor necrosis factor, interleukin-1, arachidonic acid metabolites) and activation of the complement cascade. Treatment of respiratory failure in pregnancy is largely supportive, including mechanical ventilation, hemodynamic support, nutrition, and prophylaxis against thromboembolism. No specific therapy has as yet been proven effective for ARDS, other than treating the underlying cause. Respiratory failure from status asthmaticus is treated with vigorous bronchodilator therapy, high-dose glucocorticosteroids, magnesium sulfate, and careful ventilator management. Occasionally, more experimental therapies (e.g., isoproterenol infusion, halothane anesthesia) are indicated. Certain strategies can help prevent respiratory failure from aspiration of gastric contents, beta-adrenergic tocolytic therapy, and thromboembolic disease.
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PMID:Acute respiratory failure in pregnancy. 136 44

A treatment protocol for pediatric patients with acute asthma from 8 months to 15 years of age was utilized in an urban pediatric emergency department. In a three month period, 682 children were evaluated with acute asthma with 566 (83.0%) initially discharged and 116 (17.0%) admitted. There were no deaths. Treatment included aerosol inhalation in 682 patients (100%) and both intravenous steroids and aminophylline in 247 (36.2%) patients. Medical care was rendered by housestaff physicians supervised by full-time attending physicians. Of the 566 patients discharged, 131 (21.1%) patients had received intravenous aminophylline and steroids. Of those discharged 14 (2.5%) were admitted during the subsequent 48 hours for status asthmaticus. Of the 247 patients who received intravenous medications, chest radiographs consistent with pneumonia were noted in 15 (6.2%). The routine use of this protocol has been effective in the short term emergency department management of pediatric patients with acute asthma and had been accepted by the housestaff and attending physicians.
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PMID:A treatment protocol of the acute asthma patient in a pediatric emergency department. 142 3

Mechanical ventilation is indicated in acute respiratory failure, especially in so-called pump failure as occurs in status asthmaticus, pneumonia and ARDS due to respiratory muscle fatigue. Using clinical parameters (inspiratory paradox, respiratory alternans), together with blood gas analysis and chest X-ray morphology, the indication can be established on a rational basis. The aims of therapy are tissue oxygenation and cure of the underlying disease which has led to respiratory failure. By adapting ventilator settings to the respiratory mechanics of the individual patient, complication due to barotrauma can be avoided. Respiratory muscle rest can be assessed by monitoring tracheal pressure time curves. Unconventional methods using very small t idal volumes and very high frequency so far have no clearcut indications, as they are still investigational.
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PMID:[Indications for artificial ventilation in status asthmaticus, adult respiratory distress syndrome and pneumonia]. 219 24

Mechanical ventilation in 75 out of 560 status asthmaticus episodes during a five-year period (1984-1988) at Chulalongkorn Hospital were analyzed. There were 58 patients with an average age of onset of first asthmatic attack of 18.5 years and an average age when requiring mechanical ventilation of 33 years, which is significantly younger than among those who did not require assisted ventilation. At the time of intubation, four patients were in sudden unexpected arrest and 19 patients were urgently ventilated because of respiratory muscle fatigue or carbon dioxide narcosis; the remaining 52 patients required elective mechanical ventilation. The arterial blood gas of 52 patients revealed a pH of 7.11 +/- 0.66, PaCO2 of 58.0 +/- 5.5 mmHg, and HCO3 of 15.0 +/- 5.8 mEg/L. Controlled mechanical ventilation was maintained for a mean of 38.68 hours. Fifty-one patients required intravenous diazepam (average dose = 24.3 mg) and 37 required morphine (average dose = 11.1 mg) for good syncronization in controlling mechanical ventilation. Pneumothorax was the most common complication with four, nine and one episodes occurring prior to, during and after assisted ventilation, respectively. Four, one and two patients developed the complications of pneumonia, atelectasis of the left lung due to mucous plugging and upper gastrointestinal hemorrhage, respectively. There were six patients who died of complications: four of brain anoxia, one of pneumothorax and another of unexplained cause.
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PMID:Mechanical ventilation in status asthmaticus: experience with 75 episodes. 223 Jun 27

A review of hospital admissions of patients with status asthmaticus at the Childrens Hospital of Los Angeles showed a marked increase in admissions in recent years. Asthma mortality did not increase. Patients tended to be young, boys, and black as compared with patients admitted to a general hospital. Interviews with 100 patients and/or their parents admitted between February and June 1988 indicated that the majority of patients had frequent, severe, and/or disabling symptoms and a significant number were undertreated. Forty-five percent of these patients and 46% of all patients admitted between January 1986 and October 1988 because of status asthmaticus also had sinusitis, otitis, or pneumonitis.
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PMID:Hospitalization of children with status asthmaticus: a review. 274 Jan 60


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