Abstract

Ventilation of the asthmatic is a major challenge with a potential for catastrophic problems that can and should be anticipated. Therapy should be tailored to the individual’s needs. If managed appropriately mortality in these patients is low (less than 1%). Much of the reported morbidity relates to cerebral hypoxia at or immediately before ventilatory intervention. Early use of CPAP in asthmatics that fail or are slow to respond to conventional therapy has been shown to significantly reduce the need for intermittent positive pressure ventilation.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Centre for Disease Control: Asthma-United States, 1982-1992. MMWR Morb Mortal Wkly Rep 1995; 43: 952-955.
2. Kearney SE, Graham DR, Atherton ST. Acute severe asthma treated by mechanical ventilation: a comparison of the changing characteristics over a 17 year period. Respir Med 1998; 92(5): 716-721.
3. Picado C. Classification of severe asthma exacerbations: a proposal. Eur Respir J 1996; 9: 1775-1778.
4. Tuxen DV, Williams TJ, Scheinkestel CD, et al; Use of a measurement of pulmonary hyperinflation to control the level of mechanical ventilation in patients with acute severe asthma. Am Rev Respir Dis 1992; 146: 1136-1142l.
5. Kallenbach JM, Frankel AH, Lapinsky SE, et al; Determinants of near fatality in acute severe asthma. Am J Med 1993; 95: 265-272.
6. Jagoda A, Sheperd SM, Spevitz A, et al; Refractory asthma, part 2:Airway intervention and management. Ann Emerg Med 1997; 29: 275-281.
7. Wasserfallen JB, Scaller MD, Feihl F, et al; Sudden asphyxic asthma: a distinct entity? Am Rev Respir Dis 1990; 142: 108-111.
8. Martin JG, Shore SA, Engel LA. Mechanical load and inspiratory muscle action during induced asthma. Am Rev Respir Dis 1983; 128: 455-460.
9. Moutain RD, Sahn S. Clinical features and outcome in patients with acute asthma presenting with hypercapnia. Am Rev Respir Dis 1988; 138: 535-539.
10. De Diego A, Perpina M, Leon M, et al; Prediction of the need for mechanical ventilation in acute severe asthma. Respiration 1996; 63: 73-77.
11. Meduri GU, Cook TR, Turner RE, et al; Non-invasive positive pressure ventilation in status asthmaticus. Chest 1996; 110: 767-774.
12. Williams TJ, Tuxen DV, Scheinkestel CD, et al; Risk factors for morbidity in mechanically ventilated patient's with acute severe asthma. Am Rev Respir Dis 1992; 146: 607-615.
13. Zimmerman JL, Dellinger RP, Shan AN, et al; Endotracheal intubation and mechanical ventilation in severe asthma. Crit Care Med 1993; 21: 1727-1730.
14. Georgopoulos D, Kondili E, Prinianakis G. How to set the ventilator in asthma. Monaldi Arch Chest Dis 2000; 55: 74-83.
15. Rodrigues-Roisin R. Acute severe asthma. Pathophysiology and pathobiology of gas exchange abnormalities. Eur Respir J 1997; 10: 1359-1371.
16. Leatherman JW, Fluegel WL, David WS, et al; Muscle weakness in mechanically ventilated patients with severe asthma. Am J Resp & Crit Care Med 1996; 153(5): 1686-1690.
17. Behbehani NA, Al-Mane F, D’yachkova Y, et al; Myopathy following mechanical ventilation for acute severe asthma: the role of muscle relaxants and corticosteroids. Chest 1999; 115(6): 1627-1631.
18. Tuxen DV. Permissive hypercapnic ventilation. Am J Respir Crit Care Med 1994; 150: 870-874.
19. Calhoun W. Management of respiratory failure. Chest 1992; 101(suppl): 410S-414S.
20. Marini JJ. Should PEEP be used in airflow obstruction. Am Rev Respir Dis 1989; 140: 1-3.
21. Koh Y. Ventilatory management of patients with severe asthma. Inter Anesthe Clin 2001; 39(1): 63-73.
22. Manthous CA, Hall JB, Melmed MA, et al; Heliox improves pulsus paradoxus and peak expiratory flow rate in nonintubated patients with severe asthma. Am J Resp Crit Care Med 1995; 151: 310-14.
23. Schaeffer EM, Pohlman A, Morgan S, et al; Oxygenation in status asthmaticus improves during ventilation with helium-oxygen. Crit Care Med 1999; 27: 2666-70.
24. Gluck EH, Onorato DJ, Castriotta R. Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis. Chest 1990; 98: 693-8.
25. Kass JE, Terregino CA. The effect of heliox in acute severe asthma. Chest 1999; 116: 296-300.
26. Jones A, Rowe B, Peters J, et al; Inhaled beta-agonists for asthma in mechanically ventilated patients. Cochrane Database Syst Rev 2000; (2): CD001493.
27. Adams S, Martin H. The emergent approach to asthma. Chest 1992; 101(suppl): 422S-425S.
28. Franklin C, Samuel J, Hu TC. Life threatening hypotension associated with emergency intubation and the initiation of mechanical ventilation. Am J Emerg Med 1994; 12: 425-428.