Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

Philippe Le Conte, Nicolas Terzi, Guillaume Mortamet, Fekri Abroug, Guillaume Carteaux, Céline Charasse, Anthony Chauvin, Xavier Combes, Stéphane Dauger, Alexandre Demoule, Thibaut Desmettre, Stephan Ehrmann, Bénédicte Gaillard-Le Roux, Valérie Hamel, Boris Jung, Sabrina Kepka, Erwan L'Her, Mikaël Martinez, Christophe Milési, Élise Morawiec, Mathieu Oberlin, Patrick Plaisance, Robin Pouyau, Chantal Raherison, Patrick Ray, Mathieu Schmidt, Arnaud W Thille, Jennifer Truchot, Guillaume Valdenaire, Julien Vaux, Damien Viglino, Guillaume Voiriot, Bénédicte Vrignaud, Sandrine Jean, Eric Mariotte, Pierre-Géraud Claret, Philippe Le Conte, Nicolas Terzi, Guillaume Mortamet, Fekri Abroug, Guillaume Carteaux, Céline Charasse, Anthony Chauvin, Xavier Combes, Stéphane Dauger, Alexandre Demoule, Thibaut Desmettre, Stephan Ehrmann, Bénédicte Gaillard-Le Roux, Valérie Hamel, Boris Jung, Sabrina Kepka, Erwan L'Her, Mikaël Martinez, Christophe Milési, Élise Morawiec, Mathieu Oberlin, Patrick Plaisance, Robin Pouyau, Chantal Raherison, Patrick Ray, Mathieu Schmidt, Arnaud W Thille, Jennifer Truchot, Guillaume Valdenaire, Julien Vaux, Damien Viglino, Guillaume Voiriot, Bénédicte Vrignaud, Sandrine Jean, Eric Mariotte, Pierre-Géraud Claret

Abstract

Background: The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients.

Results: The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines.

Conclusion: The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.

Keywords: Asthma; Emergency; Guidelines; Intensive Care; Pediatric; Severe exacerbation.

Conflict of interest statement

Philippe Le Conte reports personal fees from Novartis, outside the submitted work; Nicolas Terzi reports personal fees from Boehringer Inghelheim, personal fees from Pfizer, outside the submitted work; Guillaume Carteaux reports congress registration expanses from Orkyn, personal fees from Air Liquide Medical System, outside the submitted work; Alexandre Demoule reports personal fees from Medtronic, grants, personal fees and non-financial support from Philips, personal fees from Baxter, personal fees from Hamilton, personal fees and non-financial support from Fisher & Paykel, grants from French Ministry of Health, personal fees from Getinge, grants and personal fees from Respinor, grants and non-financial support from Lungpacer; Stéphan Ehrmann reports consultancies fees from Aerogen, Baxter healthcare, Bayer medical and La DiffusionTechnique Française, research support from Aerogen, Fisher & Paykel and Hamilton, travel expenses reimbursement from Aerogen and Fisher & Paykel; Bénédicte Gaillard-Le Roux reports non-financial support from BAXTER NUTRITION, non-financial support from FRESENIUS, outside the submitted work; Boris Jung reports travel expenses reimbursement from Sedana Medical; Erwan L’Her reports grants and personal fees from Smiths Medical, General Electrics, Sedana Medical and Oxynov Inc., all outside the submitted work; Mikaël Martinez reports personnal fees from Astra Zeneca and Actélion, outside the submitted work; Chantal Raherison eports personal fees from Mundipharma, grants and personal fees from Astra Zeneca, personal fees from ALK, grants and personal fees from Boehringer Ingelheim, grants from Chiesi, grants and personal fees from Glaxo Smith Kline, grants and personal fees from Novartis, personal fees from Zambon, outside the submitted work; Mathieu Schmidt reports personal fees from Drager, personal fees from Getinge, personal fees from Xenios, outside the submitted work; Arnaud Thille reports personal fees from Fisher&Paykel, personal fees from Covidien, personal fees from Maquet-Getinge, personal fees from GE healthcare, outside the submitted work; Damien Viglino reports grants from Mundipharma, from Astra Zeneca, outside the submitted work; Guillaume Voiriot reports grants, personal fees and non-financial support from Biomérieux, grants from Janssen, grants from SOS Oxygène, outside the submitted work; Eric Mariotte reports personal fees from Sanofi, outside the submitted work; Guillaume Mortamet, Fekri Abroug, Céline Charasse, Anthony Chauvin, Xavier Combes, Stéphane Dauger, Thibaut Desmettre, Valérie Hamel, Sabrina Kepka, Christophe Milési, Élise Morawiec, Mathieu Oberlin, Patrick Plaisance, Robin Pouyau, Patrick Ray, Jennifer Truchot, Guillaume Valdenaire, Julien Vaux, Bénédicte Vrignaud, Sandrine Jean, Pierre-Géraud Claret has nothing to disclose.

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