Bronchoscopy as a rescue therapy in patients with status asthmaticus: Two case reports and review of literature

Khan, Muhammad Faisal; Otair, Hadil A Al; Elgishy, Alaa; Alzeer, Abdulaziz H.

doi:10.4103/1658-354x.115323

Cited by 8 publications

(4 citation statements)

References 12 publications

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“…Mucus plugging causes airway inflammation and obstruction and has been seen in fatal cases of asthma exacerbations [53]. Bronchoscopy in asthmatic patients on mechanical ventilation has been found to be effective in improving PaCO 2 levels, airway compliance, and expediting extubation in case reports [54]. Although large studies evaluating bronchoscopy in severe asthma exacerbations are lacking, bronchoscopy can be considered when bronchospasm is not improving despite conventional therapy or if atelectasis and/or increasing peak airway pressures are seen.…”

Section: Bronchoscopymentioning

confidence: 99%

Critical Care Management of Severe Asthma Exacerbations

Gayen,

Dachert,

Lashari

et al. 2024

JCM

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Severe asthma exacerbations, including near-fatal asthma (NFA), have high morbidity and mortality. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Life-threatening complications of traditional ventilation strategies in asthma exacerbations include the development of systemic hypotension from hyperinflation, air trapping, and pneumothoraces. Optimizing pharmacologic techniques and ventilation strategies is crucial to treat the underlying bronchospasm. Despite optimal pharmacologic management and mechanical ventilation, the mortality rate of patients with severe asthma in intensive care units is 8%, suggesting a need for advanced non-pharmacologic therapies, including extracorporeal life support (ECLS). This review focuses on the pathophysiology of acute asthma exacerbations, ventilation management including non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV), the pharmacologic management of acute asthma, and ECLS. This review also explores additional advanced non-pharmacologic techniques and monitoring tools for the safe and effective management of critically ill adult asthmatic patients.

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Section: Bronchoscopymentioning

confidence: 99%

Critical Care Management of Severe Asthma Exacerbations

Gayen,

Dachert,

Lashari

et al. 2024

JCM

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“…The life-threatening form of asthma sometimes requires mechanical ventilation. The role of bronchoscopy in this setting is not well established [42]. However, there are several case reports supporting the efficacy of NAC administered through a bronchoscope for patients with status asthmaticus.…”

Section: Literature Reviewmentioning

confidence: 99%

Nebulised N-Acetylcysteine for Unresponsive Bronchial Obstruction in Allergic Brochopulmonary Aspergillosis: A Case Series and Review of the Literature

Otu

Langridge

Denning

2018

JoF

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Many chronic lung diseases are characterized by the hypersecretion of mucus. In these conditions, the administration of mucoactive agents is often indicated as adjuvant therapy. N-acetylcysteine (NAC) is a typical example of a mucolytic agent. A retrospective review of patients with pulmonary aspergillosis treated at the National Aspergillosis Centre in Manchester, United Kingdom, with NAC between November 2015 and November 2017 was carried out. Six Caucasians with Aspergillus lung disease received NAC to facilitate clearance of their viscid bronchial mucus secretions. One patient developed immediate bronchospasm on the first dose and could not be treated. Of the remainder, two (33%) derived benefit, with increased expectoration and reduced symptoms. Continued response was sustained over 6–7 months, without any apparent toxicity. In addition, a systematic review of the literature is provided to analyze the utility of NAC in the management of respiratory conditions which have unresponsive bronchial obstruction as a feature.

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“…[ 1 2 ] At present, however, data regarding outcomes and safety of bronchoscopy in ventilated adult patients with acute severe asthma (ASA) (formerly known as status asthmaticus) is limited to few and mostly old case reports. [ 3 4 5 6 ] Regarding a recent interesting publication in the Saudi Journal of Anesthesia on this topic by Khan et al .,[ 7 ] there are some relevant aspects that need reviewing:…”

mentioning

confidence: 99%

“…Khan et al . [ 7 ] in their study have reported about two intubated patients whose asthma is refractory to medical treatment and are subjected to bronchoscopy for suspected mucus plugs. The authors inform of a significant improvement in airway pressures and gas exchange after bronchial lavage in both patients and no significant immediate complications, which is a remarkable finding.…”

mentioning

confidence: 99%