Management of Acute Life-Threatening Asthma Exacerbations in the Intensive Care Unit

Abstract

Managing acute asthma exacerbations in critical care can be challenging and may lead to adverse outcomes. While standard management of an acute asthma exacerbation is well established in outpatient and emergency department settings, the management pathway for patients with life-threatening and near-fatal asthma still needs to be fully defined. The use of specific interventions such as intravenous ketamine, intravenous salbutamol, and intravenous methylxanthines, which are often used in combination to improve bronchodilation, remains a contentious issue. Additionally, although it is common in the intensive care unit setting, the use of non-invasive ventilation to avoid invasive mechanical ventilation needs further exploration. In this review, we aim to provide a comprehensive overview of the available treatments and the evidence for their use in intensive care. We highlight the ongoing need for multicentre trials to address clinical knowledge gaps and the development of intensive-care-based guidelines to provide an evidence-based approach to patient management.

From Bronchodilation to Lactic Acidosis: A Case Report on Salbutamol’s Adverse Effect

“…In such circumstances, the most appropriate treatment is SABA eviction while continuing other recommended combination therapies, such as ipratropium bromide, oral/intravenous corticosteroids, and magnesium sulfate. Should invasive mechanical ventilation be necessary and the condition remains refractory to standard medical therapy, other options, including helium-oxygen therapy or ketamine, may be available, although the evidence supporting their use is weak [14,2].…”