Mechanical Ventilation in Patients with Acute Severe Asthma

Mansel, J. Keith; Stogner, Steven W.; Petrini, Marcy F.; Norman, Joe R.

doi:10.1097/00132586-199108000-00044

Cited by 7 publications

(7 citation statements)

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“…Isso está associado à morbidade significativa causada por barotrauma, instabilidade hemodinâmica, infecções e aumento no tempo de internação [67][68][69] . A VNI nesses pacientes é, portanto, importante para eliminar essas complicações indesejáveis.…”

Section: Obstrução Das Vias Aéreas Inferioresunclassified

Noninvasive ventilation in children: a review

Loh¹,

Chan²,

Chan³

2007

J Pediatr (Rio J)

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Section: Obstrução Das Vias Aéreas Inferioresunclassified

Noninvasive ventilation in children: a review

Loh¹,

Chan²,

Chan³

2007

J Pediatr (Rio J)

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“…17,19,20 In our study, 6 patients (7%) died; 3 patients died after suffering pre-MICU cardiac arrest, and 3 patients died of multiorgan failure. Regular asthma clinic follow-up, to include counseling about smoking cessation and illicit drugs, is essential.…”

Section: Discussionmentioning

confidence: 52%

Increasing severity of status asthmaticus in an urban medical intensive care unit

Elsayegh

Saito

Eden

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Life‐threatening status asthmaticus (SA) requiring intensive care is a major concern given the rising prevalence of asthma. We examined episodes of SA requiring admission to the medical intensive care unit (MICU) of an urban hospital center.METHODOLOGY:The charts of patients admitted to the MICU of an urban hospital center with a diagnosis of SA during the 5‐year period 2002–2006 were reviewed retrospectively. These results were compared with those of a previously published experience at our institution from 1995 to 1999.RESULTS:The medical records of 84 MICU admissions for SA were reviewed. There were 61 women (5 pregnant). The mean age was 44 years. Use of cigarettes or illicit drugs was found in 51% and 30%, respectively. Mechanical ventilation (MV) was required in 76% of admissions. Noninvasive ventilation was used in 10 patients. Neuromuscular blockade (NMB) was needed in 9% of admissions. The highest average PaCO2 during the first 24 hours was 67 mm Hg. Median duration of MV was 4.4 days. Six patients died, 3 of whom sustained prehospital cardiac arrest. Compared with the patients in the preceding 5‐year period, the more recent patients had greater use of illicit drug and cigarettes. Patients presented with more severe asthma, as reflected by a higher PaCO2 and an increased duration of MV.CONCLUSIONS:During the recent 5‐year period, we found a trend toward increasing severity of SA, as indicated by the degree of respiratory acidosis, need for NMB, and longer duration of MV. Access to medical care and cigarette and illicit drug use remain potential targets of primary intervention. Journal of Hospital Medicine 2008;3:206–211. © 2008 Society of Hospital Medicine.

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“…these patients would probably have died if they had not been treated aggressively. Thus, they rL·prese nt a subgroup of patien ts who die from asthma; this is true for otlwr studies (38,(43)(44)(45)(46)(47)(48)(49)(50)(51).…”

Section: How Generalizable Are Studies In Nfa To Fatal and Severe Astmentioning

confidence: 96%

Proceedings of a Workshop on Near Fatal Asthma

FitzGerald

Macklem

1995

Canadian Respiratory Journal

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.JM FITZ<.iERALI), PT MACKLF:M. Proceedings of a workshop on near fatal asthma. Can Respir .J 1995;2(2): l 13-126.Corll'LTn has been L'XpressL'd aboul rising asthma morbid ity and mortal ity, although till' latter appears to have decline d recently. A reasonable surrog ate for fatal as thma is an episode of near fatal asthma (NFA). The e tiology of episodes of NFA appears to be multifactorial. Features that w ou ld characteri1.e asthma patients at risk of NFA h ave been diffiL'lllt to defi ne but have included psychosocial barriers. environmental exposure s, inadequa te or inappropriate physiL·ian aml/or patient res ponses to deteriorati ng asth ma and , in particular, overreliance on symptomatic bronc hodil ato r therapy. The association between fatal asthma and NFA with hcta-agonist use has been controvers ial, with it being argued that high use of beta-agonists reflect s severity of as thma as opposed to being causal. Studies in the laboratory and ambulatory care setting suggest that regular compared with as-rc4uircd use of beta-agonists is a ssoci ate d with worsening in asthma control. Although a reduced pe rception of dyspnea has been identified in some a sthma patient s, it is not universal ly present in those with NFA. Retrospective data suggest that hyperinflation of the thora x, as judged by total lung capacity, may be a useful marker for subjects at risk of NFA . f<"uture studies should better characteri ze these ris1' factors and develop manage ment s trateg ies (both therapeutic and educational) that might reduce the risk of subjects experienc ing episodes of NFA and, by exte n sion, red uc ing the continm·J unacccptahk mortality associated with asthma .

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Mechanical Ventilation in Patients with Acute Severe Asthma

Cited by 7 publications

References 0 publications

Noninvasive ventilation in children: a review

Noninvasive ventilation in children: a review

Increasing severity of status asthmaticus in an urban medical intensive care unit

Proceedings of a Workshop on Near Fatal Asthma

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