Divergencias sobre manejo de la crisis asmática en niños en urgencias

Resumen

BACKGROUND AND OBJECTIVES. Asthma exacerbations are the most common emergencies seen in pediatric emergency departments (PEDs). Recommendations in international guidelines give the basis for treating these exacerbations, but there is no consensus about some treatments because of lack of evidence. We designed a questionnaire to survey the management practices used in Spanish PEDs and identify differences between them. A secondary aim was to compare these practices with those reported during a survey distributed in 2012. MATERIAL AND METHODS. A 20-item questionnaire on the management of childhood asthma was designed and sent to members of the Spanish Society of Pediatric Emergencies (SEUP). The responses were compared with those collected by the same research group 10 years earlier. RESULTS. A total of 269 responses were received from 72 hospitals in 16 Spanish autonomous communities. More than 90% of the respondents surveyed use the Pulmonary Score for the initial evaluation, and the treatment of mild to moderate exacerbations with metered dose bronchodilators is now widespread (95% of respondents). Likewise, spacers are now used by the vast majority (99.3%). Nebulized bronchodilators are administered by 52% of the respondents for severe exacerbations. A majority (69%) use a weight-based rule (weight/3) to calculate the number of puffs of salbutamol to administer. Protocols for administering ipratropium bromide are highly diverse. Prednisolone is the oral corticosteroid most widely used (68.5%), followed by dexamethasone (30%). The second-line treatment used most often is magnesium sulfate (91.8%), followed by high-flow oxygen therapy (58.7%). Notable changes since the earlier survey include significantly greater use of the Pulmonary Score for evaluation (91.1% vs 43%; P < .01), use of metered dose inhalers to administer bronchodilators in moderate exacerbations (95.2% vs 40.7% in ; P = .02) and severe exacerbations (48% vs 2.7% ; P < .01), and administration of magnesium sulfate (91% vs 12%). CONCLUSION. We detected differences between PEDs with respect to the doses and forms of administering bronchodilators, the usual choices of oral corticosteroids, second-line treatments, and regimens prescribed for home management.