Peds

Pediatric severe asthma

Before / During / After / Pitfalls

Before

• Maximize medical therapy and NIV/HFNC when safe; intubation is high risk.
• Use measured/length-based weight, peds color zone, and stage age-appropriate equipment.
• Plan obstructive ventilator settings before the tube.

During

• Avoid air trapping with bagging; gentle rate and pressure.
• Cuffed tube size from weight/age, one size up/down ready.
• Confirm with EtCO2 but remember severe obstruction can produce low waveform initially.

After

• Low RR, long exhalation, close waveform monitoring.
• Sedation/paralysis for dangerous dyssynchrony per peds ICU/ED protocol.
• Continuous bronchodilators and ICU consultation.

Pitfalls

• Ventilating like a normal child.
• No backup tube sizes.
• Delayed recognition of auto-PEEP shock.