Bronchial Asthma in Children: A Clinical, Diagnostic and by Lahiri

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Prolong the expiratory phase by increasing expiratory flow and decreasing the respiratory rate. • Elevated PaCO2 levels carries a small risk of cardiac dysrhythmias and hypertension. • FiO2 is regulated to maintain oxygen saturation levels of > 90% and FiO2 rather than PEEP (positive end expiratory pressure) is increased to prevent barotrauma. • Close attention should be given to maintaining or replacing intravascular volume because hypotension commonly accompanies the initiation of PIP. • Expert panel recommends that intubations not be delayed once it is deemed necessary.

Dose related toxicities include tachycardia, nausea and vomiting, tachyarrythmias, hyperglycaemia and hypokalaemia. 2 (age in weeks) + 5 = mgm/kg/day. Maintain serum theophylline level of 5-15 μgm/ml/> 1 year of age: 16 mgm/kg/day. 6 CHAPTER Leukotriene Modifiers LEUKOTRIENE MODIFIERS Leukotrienes are potent biochemical mediators released from mast cells, eosinophils and basophils that contract airway smooth muscle, increase vascular permeability, increase mucus secretion, and attract and activate inflammatory cells in the airways of children with asthma.

Sellick maneuver (cricoid pressure) during intubation can decrease the risk of aspiration. • Correct placement of ET tube is monitored by end-tidal CO2 monitor, equal bilateral breath sounds, visualisation of chest movement and radiography. Ventilatory Management The goals of mechanical ventilation: a. Provide adequate oxygenation b. Provide adequate ventilation c. Decrease the work of breathing. “Permissive Hyperapnea or Controlled Hypoventilation is recommended” • PaCO2 is allowed to remain higher than usual by decreasing ventilator settings.

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