Acute Asthma Exacerbation Clinical Pathway – PICU – Standard Medications

Acute Asthma Exacerbation Clinical Pathway – PICU

Standard Medications

Medication Dosing
Continuous Albuterol
Doses up to 20 mg/hr have been used for escalation		 Weight (kg) Dose (0.5% solution)
5–10 7.5 mg/hr (1.5 mL/hr)
> 10–20 11.25 mg/hr (2.25 mL/hr)
> 20 15 mg/hr (3 mL/hr)
Ipratropium Weight (kg) Dose
5–10 250 mcg/dose nebulized q6hr
> 10 500 mcg/dose nebulized q6hr
Methylprednisolone

Methylprednisolone Dosing based on Pre-ICU Steroid Exposure

Pre ICU Steroid Exposure Recommended ICU Dosing Timing of ICU Administration
Dexamethasone Methylprednisolone 1 mg/kg/dose IV q6hr
Max 30 mg/dose		 Start 6 hrs after last dose of dexamethasone
Methylprednisolone
or
Prednisone		 Methylprednisolone 1 mg/kg/dose IV q6hr
Max 30 mg/dose		 Start 6 hrs after last dose of methylprednisolone or prednisone
No steroids Methylprednisolone 2 mg/kg IV once, Max 60 mg,
then 1 mg/kg/dose IV q6hr, Max 30 mg/dose		 Start immediately
Inhaled Maintenance Steroid Hold while receiving systemic methylprednisolone or prednisone

Escalation Medications

Order of Initiation Medication Timing of Initiation Dosing
1 Magnesium Sulfate On maximum dose albuterol and ipratropium with persistent poor air entry 50 mg/kg/dose IV over 20 mins, Max 2,000 mg/dose
2 Terbutaline On maximum dose albuterol and ipratropium with persistent poor air entry and inadequate response to magnesium sulfate
  • Loading dose: 2–10 mcg/kg IV, Max 400 mcg
  • Continuous infusion 0.1–0.4 mcg/kg/min;
    titrate by clinical response up to 3 mcg/kg/min
3 Heliox
  • If all criteria are present:
    • FiO2 ≤ 30%
    • Inadequate air entry with maximum dose albuterol and ipratropium
  • Note
    • Requires removal from NIPPV
      Use as a trial prior to mechanical ventilation
 Heliox Therapy Procedure