Use of Noninvasive Ventilation in Adult Patients With Acute Asthma Exacerbation

Abstract

Noninvasive ventilation (NIV) has been found to be beneficial for respiratory failure in many disease states; however, limited data are available supporting its use in acute asthma exacerbation. A retrospective chart analysis of adult patients admitted for acute asthma exacerbation and treated with NIV between January 2007 and December 2009 at a tertiary care community hospital was done. Ninety-eight patient encounters were identified. Mean age of the patients was 48.3 years, and 46% were male. Nineteen patients failed NIV and required invasive ventilation. There was no significant difference in the mean age, sex, race, and initial blood gas between patients with successful versus failed NIV. Usage of drugs, smoking, and history of past hospital or intensive care unit admission or intubation did not significantly influence the rate of failure of NIV. Patients who needed higher initial FiO2 were more likely to get intubated during their hospital stay (46.2 vs. 20.4%, P = 0.019). Patients who failed NIV were found to have longer duration of hospital stay (6.8 vs. 3.9 days, P= 0.016) and longer intensive care unit stay (4 vs. 0.9 days, P = 0.002). Use of inhalers and other medications was not found to significantly influence the rate of failure of NIV. NIV can be used initially in patients with acute asthma exacerbation, as it is associated with shorter duration of hospital stay and can prevent the morbidity of mechanical intubation. Patients with initial requirement of higher FiO2 were more likely to fail NIV and should be carefully monitored.

Outcomes of Noninvasive and Invasive Ventilation in Patients Hospitalized with Asthma Exacerbation

“…One explanation for the marked difference in mortality in our study is that NIV may have been used mainly in patients with lower severity of illness and not in borderline patients who failed standard medical therapy (28,29). The low rate of NIV failure in our study (4.7%) is in contrast with the rate of 19.4% reported in a study of 98 patients with a severe acute asthma exacerbation who failed routine treatment treated with NIV in the emergency department (30). The low rate of NIV failure also provided additional evidence that NIV was being used selectively in a lower-risk group.…”

Non‐invasive ventilation use in status asthmaticus: 16 years of experience in a tertiary intensive care

“…Our failure rate for NIV was 4.5%, similar to a large American retrospective cohort from an electronic medical record database but less than other studies . Leatherman reports a failure rate of 17% across five studies .…”

“…Other studies of NIV in asthma also report low or no complication rates . The haemodynamic effects of positive pressure ventilation are also less marked in spontaneous breathing patients …”

“…18 Other studies of NIV in asthma also report low or no complication rates. [19][20][21] The haemodynamic effects of positive pressure ventilation are also less marked in spontaneous breathing patients. 8 The rates of IMV (11.7%) in our study were lower than previous studies but our total (IMV and NIV) rate of ventilation was 78%.…”

Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure

“…A few uncontrolled studies and RCTs have compared NIV versus routine care in patients with acute asthma [55,56]. Uncontrolled studies have shown physiological improvements in selected patients, whereas the RCTs and a meta-analysis have not shown differences in clinically relevant outcomes when comparing NIV with usual care [57].…”