Sep 27, 2022
Contributor: Aaron Lessen, MD
Educational Pearls:
- The management of severe asthma or COPD
exacerbation is complex, especially when the patient requires
intubation/ventilation
- Asthma is an obstructive airway disease that
can cause air trapping and hyperinflation of the lungs
- To avoid worsening hyperinflation patients
typically require slower respiratory rates, lower tidal volumes,
and increased expiratory time when on a ventilator
-
- Patients on a ventilator require very close
monitoring to prevent worsening hyperinflation and associated
complications including barotrauma and hypotension/cardiac arrest
secondary to decreased venous return
- If
patient condition starts to worsen, decrease respiratory rate and
tidal volume
-
- In
these cases, a decreased oxygen saturation is acceptable until
their condition improves
- If patient status continues to worsen, consider
disconnecting the ventilator and pushing on the chest for
approximately 30 seconds to help force out trapped air
- If patient continues to decompensate, consider
the possibility of a pneumothorax and determine if a chest tube is
necessary
- Remember to continue asthma/COPD management
including albuterol/duonebs, steroids, magnesium, and alternatives
including as heliox
References
Demoule A, Brochard L, Dres M,
et al. How to ventilate obstructive and asthmatic patients.
Intensive Care Med.
2020;46(12):2436-2449
Garner O, Ramey JS, Hanania NA.
Management of Life-Threatening Asthma: Severe Asthma Series.
Chest. 2022
Laher AE, Buchanan SK.
Mechanically Ventilating the Severe Asthmatic.
J Intensive Care
Med. 2018;33(9):491-501
Summarized by Mark O’Brien,
MS4 | Edited by John Spartz MD & Erik Verzemnieks,
MD
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