[Severe asthmatic crisis in children].

The aim of the present study was to evaluate clinical and laboratory features of acute severe asthma (ASA) in children and their outcome of mechanical ventilation (MV). Twenty ASA episodes admitted to the hospital with hypercapnia (HC) and/or lost of consciousness (LC) and/or severe non reversible bronchial obstruction (NRBO) were retrospectively studied. Long lasting asthma and frequent admissions were registered in the majority of cases. In HC group (14 cases) the PaCO2 was 70 +/- 26 mmHg (X +/- SD). Hypercapnia was associated with intravenous administration of sodium bicarbonate in three cases. In NRBO group (4 cases) the acute response to salbutamol brought out during the first week of treatment and it was associated with increased basal forced expiratory volume in one second (FEV1). Ten cases were treated with MV because of hypercapnia and/or lost of consciousness, seizures (one case), and cardiac arrest (one case). The later patient died in 24 hours. Pneumothorax and atelectasis (one case), and pneumonia (one case) were the complications of mechanical ventilation. Three cases with PaO2 less than 60 mmHg and four cases with FEV1 less than 60% were sent home. After 27 days one patient from the later group had a new episode of ASA. Arterial gases and expiratory flow measurements are paramount tools for close monitoring of children with ASA. It is suggested that normalization of those parameters are an essential criteria for discharging those patients.