Care for severe acute asthma in pediatric intensive units

Mortality in cases of severe asthma attacles in children is evaluated at 1% . During initial medical care, repeated evaluation of clinical and para-cli nical severity criteria constitutes the main therapeutic guide. Emergency c are treatment is based mainly on oxygen therapy, bronchodilatory therapy by discontinuous inhalation, and general corticotherapy. Intravenous theophyl line treatment is controversial. The response after a few hours should allo w a decision to be made [1] to follow up with outpatient treatment (rapid m arked improvement), [2] to continue the hospital treatment (stabilization), or [3] to transfer to intensive care (worsening, exhaustion). In the inten sive care unit, the treatment is based on continuous intravenous administra tion of beta(2) mimetics in addition to the above therapies. The objective is to avoid resorting to assisted ventilation. When this proves necessary, it must not be detrimental; controlled alveolar hypoventilation allows dyna mic hyper-inflation linked to ventilation to be reduced. Prevention of rela pse is indispensable. This requires hospitalization in a specialized care u nit after discharge from intensive care.