Association hélium-sévoflurane : une thérapeutique de sauvetage dans l’asthme aigu grave

We report the case of a severe acute asthma, which required, after optimal medical therapy, helium and sevoflurane CO-administration after tracheal intubation. The Anesthetic Conserving Device^® allowed sevoflurane use with intensive care unit's ventilator. The helium-sevoflurane association was maintained during 9 days to decrease the bronchospasm, waiting for the efficiency of an aetiologic treatment. We discuss the suitability of this association to treat severe acute asthma, and its administration modalities.     

Traitement aux urgences des crises d’asthme par nébulisations versus chambres d’inhalation

Objective

To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma.

Methods

In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15 mg/kg) or puffs of a beta 2 agonist (salbutamol 50 μg/kg or terbutaline 125 μg/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO₂, respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later.

Results

Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N = 40, spacer N = 39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P < 0.02). The overall length of stay in the emergency department was significantly shorter (148 ± 20 vs 108 ± 13 min, P < 10⁻⁹).

Conclusions

The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.