Mechanically Ventilating the Severe Asthmatic

Laher, Abdullah E.; Buchanan, Sean

doi:10.1177/0885066617740079

Cited by 31 publications

(33 citation statements)

References 77 publications

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“…All patients were known to have asthma. Atopy was found in 87% of the patients, and the diagnosis of asthma was made 21 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] years earlier. A quarter of the patients had a previous episode of ASA that required IMV.…”

Section: Resultsmentioning

confidence: 99%

“…Patients received 1,000 [0-1,750] mL of fluids on the day of admission. Mechanical ventilator settings on the day of admission were as follows: a tidal volume of 405 [375-455] mL, a respiratory rate of 15 [12][13][14][15][16] breaths/min, a positive end-…”

Section: Therapeutic Management On the Day Of Admissionmentioning

confidence: 99%

“…The rate of tracheostomy was 7%. Hospital and ICU length of stay was 13 [8][9][10][11][12][13][14][15][16][17] and 7 [4][5][6][7][8][9][10][11][12] days, respectively, with IMV being administered for a period of 4 [2][3][4][5][6][7][8][9] days. These data are summarized in S3 Table. In-ICU mortality was 14% (n = 11) and in-hospital mortality was 15% (n = 12).…”

Section: Salvage Therapiesmentioning

confidence: 99%

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Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

et al. 2020

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Patients with acute severe asthma (ASA) may in rare cases require invasive mechanical ventilation (IMV). However, recent data on this issue are lacking. Materials and methods In this retrospective and bicentric study conducted on a 10 year period, we investigate the in-hospital mortality in patients with ASA requiring IMV. We compare this mortality to that of patients with other types of respiratory distress using a standardized mortality ratio (SMR) model. Results Eighty-one episodes of ASA requiring IMV were evaluated. Factors significantly associated with in-hospital mortality were cardiac arrest on day of admission, cardiac arrest as the reason for intubation, absence of decompensation risk factors, need for renal replacement therapy on day of admission, and intubation in pre-hospital setting. Non-survivors had higher SAPS II, SOFA, creatinine and lactate levels as well as lower blood pressure, pH, and HCO 3 on day of admission. In-hospital mortality was 15% (n = 12). Compared to a reference population of 2,670 patients, the SMR relative to the SAPS II was very low at 0.48 (95% CI, 0.25-0.84). The only factor independently associated with in-hospital mortality was cardiac arrest on day of admission. In-hospital mortality was 69% in patients with cardiac arrest on day of admission and 4% in others (p < 0.01). Salvage therapies were given to 7 patients, sometimes in combination with each other: ECMO (n = 6), halogenated gas (n = 1) and anti-IL5 antibody (n = 1). Death occurred in only 2 of these 7 patients, both of whom had cardiac arrest on day of admission.

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Section: Resultsmentioning

confidence: 99%

Section: Therapeutic Management On the Day Of Admissionmentioning

confidence: 99%

Section: Salvage Therapiesmentioning

confidence: 99%

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Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

et al. 2020

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“…In the context of near-fatal asthma exacerbations, ECMO provides a management strategy for difficult-to-ventilate patients who would otherwise be unlikely to survive. Importantly, in asthma, traditional mechanical ventilation strategies can be associated with volutrauma and barotrauma due to the high pressures required in the presence of severe bronchospasm [2]. To date, there is a paucity of data for ECMO use in acute asthma and it is unknown whether specific clinical or inflammatory characteristics are associated with the need for ECMO.…”

Section: Inflammatory and Microbiological Associations With Near-fatamentioning

confidence: 99%

Inflammatory and microbiological associations with near-fatal asthma requiring extracorporeal membrane oxygenation

et al. 2020

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Extracorporeal membrane oxygenation (ECMO) has developed as a critical tool permitting lung protection in severe respiratory failure. Its use was largely confined to acute respiratory distress syndrome [1]; however, as technology has advanced, it is now used in a range of respiratory diseases, including asthma. In the context of near-fatal asthma exacerbations, ECMO provides a management strategy for difficult-to-ventilate patients who would otherwise be unlikely to survive. Importantly, in asthma, traditional mechanical ventilation strategies can be associated with volutrauma and barotrauma due to the high pressures required in the presence of severe bronchospasm [2]. To date, there is a paucity of data for ECMO use in acute asthma and it is unknown whether specific clinical or inflammatory characteristics are associated with the need for ECMO.We performed a retrospective review of all adult asthmatics requiring mechanical ventilatior and/or ECMO for near-fatal asthma admitted to our single large tertiary hospital between 2011 and 2016. Clinical and demographic data including ventilator parameters, biochemical and immunological indices, and microbiology isolates were recorded. We compared patients requiring ECMO with patients requiring conventional mechanical ventilation only, to identify any factors that were significantly associated with the need for ECMO.All data, including demographic, physiological and laboratory data, utilised in this study were collected as part of routine acute asthma care in our intensive care unit (ICU) and tertiary severe asthma centre. No additional ethical approval was required. 76 patients (46% female, mean±SD age 39±16 years) with a primary diagnosis of acute asthma associated with the clinical features of a near-fatal exacerbation requiring ECMO or mechanical ventilation were included in this analysis. 22 patients (29%) required ECMO and 54 (71%) required conventional mechanical ventilation only. Compared to patients requiring mechanical ventilation, those requiring ECMO were more likely to be female (72% versus 35%, p=0.003) and younger (mean age 30±14 versus 43±15 years, p=0.002). Prior to intervention, patients requiring ECMO had a higher total white cell count (15.5±6.4 versus 12.2±4.4×10 9 L −1 , p=0.013), were more acidotic (mean pH 7.12±0.17 versus 7.27±0.09, p<0.001) and hypercapnic (mean carbon dioxide tension 12.8±4.1 versus 7.26±2.1 kPa, p<0.001). No statistically significant differences in oxygenation (oxygen tension), C-reactive protein (CRP), total serum immunoglobulin E or blood eosinophil counts at the time of admission to the ICU were observed between groups. Patients requiring ECMO were more likely to have a positive fungal isolate from bronchoalveolar lavage (BAL) fluid than those requiring mechanical ventilation (36% versus 10%, p=0.026). Rhinovirus was also identified in a greater proportion of respiratory isolates in the ECMO cohort compared to mechanical ventilation (27.2% versus 6.9%, p=0.048) with a strong trend towards a greater likelihood of any respira...

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“…As noninvasive mechanical ventilation (NIV) has recently become a treatment standard in COPD [ 3 ] and also a popular treatment option for patients with respiratory insufficiency in the course of CF [ 4 ] or asthma [ 5 ], attempts are made to couple it with aerosol therapy for patients' benefit [ 6 , 7 ]. Use of corticosteroids and bronchodilators during NIV has demonstrated a clinical benefit in both asthma and COPD [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Inhalation Techniques Used in Patients with Respiratory Failure Treated with Noninvasive Mechanical Ventilation

Rzepka-Wrona

Skoczyński

Wrona

et al. 2018

Canadian Respiratory Journal

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The administration of aerosolized medication is a basic therapy for patients with numerous respiratory tract diseases, including obstructive airway diseases (OADs), cystic fibrosis (CF), and infectious airway diseases. The management and care for patients requiring mechanical ventilation remains one of the greatest challenges for medical practitioners, both in intensive care units (ICUs) and pulmonology wards. Aerosol therapy is often necessary for patients receiving noninvasive ventilation (NIV), which may be stopped for the time of drug delivery and administered through a metered-dose inhaler or nebulizer in the traditional way. However, in most severe cases, this may result in rapid deterioration of the patient's clinical condition. Unfortunately, only limited number of original well-planned studies addressed this problem. Due to inconsistent information coming from small studies, there is a need for more precise data coming from large prospective real life studies on inhalation techniques in patients receiving NIV.

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Mechanically Ventilating the Severe Asthmatic

Cited by 31 publications

References 77 publications

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

Inflammatory and microbiological associations with near-fatal asthma requiring extracorporeal membrane oxygenation

Inhalation Techniques Used in Patients with Respiratory Failure Treated with Noninvasive Mechanical Ventilation

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