Endotracheal intubation and mechanical ventilation in severe asthma

Zimmerman, Janice L.; Dellinger, R. Phillip; Shah, Anjana K.; Taylor, Robert J.

doi:10.1097/00003246-199311000-00023

Cited by 88 publications

(45 citation statements)

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“…This high rate of adverse events is consistent with a report by Zimmerman et al [7], who found that 52.8% of BAE patients experienced one or more ETI-associated adverse events and 19.5% experienced post-intubation complications that included dysrhythmias and hypotension. The risk of emergency ETI-associated complications in severe BAE was three times that of past mixed case studies that included both medical and trauma patients [8,11].…”

Section: Attenuation Of the Risks Of Eti-related Adverse Events In Basupporting

confidence: 91%

“…Assuming that 50% of BAE patients who underwent emergency ETI experienced adverse events [7], a sample size of 20 patients per group provides 80% statistical power to detect a relative risk ≥ 2.5 and ≤ 0.4 for a two-sided significance level of p < 0.05.…”

Section: Sample Sizementioning

confidence: 99%

“…Patients with BAE requiring emergency endotracheal intubation (ETI) have little respiratory reserve and are at high risk of rapid decline in oxygen saturation during the procedure, and ETI attempts can exacerbate bronchospasm and worsen respiratory status. Many authors [4][5][6][7] have recommended that intubation of patients with severe BAE be performed by an experienced provider. However, no objective data are available on the association between the specialty of a laryngoscopist and adverse events during emergency ETI in severe BAE.…”

Section: Introductionmentioning

confidence: 99%

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Emergency endotracheal intubation-related adverse events in bronchial asthma exacerbation: can anesthesiologists attenuate the risk?

et al. 2015

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Number of tables: 6 2 AbstractPurpose Airway management in severe bronchial asthma exacerbation (BAE) carries very high risk and should be performed by experienced providers. However, no objective data are available on the association between the laryngoscopist's specialty and endotracheal intubation (ETI)-related adverse events in patients with severe bronchial asthma. In this paper, we compare emergency ETI-related adverse events in patients with severe BAE between anesthesiologists and other specialists.Methods This historical cohort study was conducted at a Japanese teaching hospital. We analyzed all BAE patients who underwent ETI in our emergency department from January 2002 to January 2014.Primary exposure was the specialty of the first laryngoscopist (anesthesiologist vs. other specialist).The primary outcome measure was the occurrence of an ETI-related adverse event, including severe bronchospasm after laryngoscopy, hypoxemia, regurgitation, unrecognized esophageal intubation, and ventricular tachycardia. Conclusion Anesthesiologist as first exposure was independently associated with attenuated risk of 3 ETI-related adverse events in patients with severe BAE. The skill and knowledge of anesthesiologists should be applied to high-risk airway management whenever possible. Results

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Section: Attenuation Of the Risks Of Eti-related Adverse Events In Basupporting

confidence: 91%

Section: Sample Sizementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Emergency endotracheal intubation-related adverse events in bronchial asthma exacerbation: can anesthesiologists attenuate the risk?

et al. 2015

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“…Similarly, several studies conducted during the last two decades have reported mortality rates ranging from 0% to 6%. (23)(24)(25) In contrast, mortality was significantly higher among patients suffering cardiopulmonary arrest (24.7%). Deaths occurred almost exclusively in female asthma patients and in patients > 55 years of age.…”

Section: Discussionmentioning

confidence: 93%

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

et al. 2009

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Objective: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. Methods: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-American countries. We reviewed the hospital records of 3,038 patients (age range, 15-69 years) hospitalized with acute severe asthma at one of nineteen tertiary-care hospitals in 1994, 1999 and 2004. Results: Over time, the use of inhaled corticosteroids and long-acting β 2 agonists increased significantly, whereas the use of theophylline as a controller medication decreased. The utilization of pulmonary function tests also increased. There was a significant reduction in the mean hospital stay (8.5 days, 7.4 days and 7.1 days in 1994, 1999 and 2004, respectively, p = 0.0001) and a significant increase in the mean of the lowest arterial pH at hospital admission. In contrast, there was a significant decrease in the proportion of cases in which PEF was determined in the emergency room (48.6% in 1994 vs. 43.5% in 2004, p = 0.0001). We found the quality of asthma management and care to be generally better in Spain than in Latin America. Conclusions: Although there have been certain improvements in the management of asthma between severe exacerbations and during hospitalization, asthma management remains suboptimal in Spain and, especially, in Latin America.Keywords: Status asthmaticus; Asthma/therapy; Hospitalization. ResumoObjetivo: Estudos que avaliem as características e o gerenciamento de pacientes asmáticos hospitalizados têm sido limitados a um número pequeno de serviços e a curtos períodos de duração. O presente estudo avaliou alterações de longo prazo de pacientes asmáticos hospitalizados em um grande número de serviços. Métodos: Estudo retrospectivo, observacional, de base hospitalar, denominado Estudo sobre Asma Grave na América Latina e Espanha, realizado na Espanha e em oito países da América Latina. Foi realizada uma revisão dos registros hospitalares de 3.038 pacientes (variação de idade, 15-69 anos) hospitalizados com asma aguda grave em um dos 19 hospitais terciários em 1994, 1999 e 2004. Resultados: Ao longo do tempo, o uso de corticosteroides inalatórios e de β 2 -agonistas aumentou significativamente, ao passo que o uso de teofilina, como medicação de controle, decaiu. A utilização de testes de função pulmonar também aumentou. Houve uma redução significativa da média do tempo de internação (8,5 dias, 7,4 dias e 7,1 dias em 1994, 1999 e 2004, respectivamente; p = 0,0001) e um aumento significativo da média do menor pH arterial na admissão. Em contrapartida, houve uma diminuição significativa na proporção de casos submetidos ao PFE no pronto-socorro (48,6% em 1994 vs. 43,5% em 2004; p = 0,0001).O tratamen...

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“…Intubation and ventilation is not an innocuous procedure, and has been associated with significant morbidity and mortality (11). Zimmerman et al (12) reported that one or more complications occurred in 46% of intubated asthmatic patients. More than one-third of all complications occurred during intubation and 47% during the intensive care unit stay.…”

Section: Intubationmentioning

confidence: 99%

Ventilatory Care in Status Asthmaticus

Smyth¹

1998

Canadian Respiratory Journal

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Asthma continues to pose a significant medical problem in terms of both morbidity and mortality. A number of patients with a severe exacerbation of asthma fail medical therapy and require urgent intubation and mechanical ventilation. New modalities of ventilatory support, including noninvasive ventilation, have been shown to provide effective ventilation even in the presence of severe bronchoconstriction. An intrinsically high level of auto positive end-expiratory pressure in these patients requires a precise balance between respiratory frequency, tidal volume and inspiratory flow rates. Pressure support ventilation reduces the risk of barotrauma and lowers the work of breathing in these patients. Adjuvant therapy with inhaled anesthetics and bronchoalveolar lavage may also be indicated in patients requiring high pressures to achieve adequate ventilation.

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Endotracheal intubation and mechanical ventilation in severe asthma

Cited by 88 publications

References 0 publications

Emergency endotracheal intubation-related adverse events in bronchial asthma exacerbation: can anesthesiologists attenuate the risk?

Emergency endotracheal intubation-related adverse events in bronchial asthma exacerbation: can anesthesiologists attenuate the risk?

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

Ventilatory Care in Status Asthmaticus

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