Sep 27, 2022
Contributor: Aaron Lessen, MD
- The management of severe asthma or COPD
exacerbation is complex, especially when the patient requires
- 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
patient condition starts to worsen, decrease respiratory rate and
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
- Remember to continue asthma/COPD management
including albuterol/duonebs, steroids, magnesium, and alternatives
including as heliox
Demoule A, Brochard L, Dres M,
et al. How to ventilate obstructive and asthmatic patients.
Intensive Care Med.
Garner O, Ramey JS, Hanania NA.
Management of Life-Threatening Asthma: Severe Asthma Series.
Laher AE, Buchanan SK.
Mechanically Ventilating the Severe Asthmatic.
J Intensive Care
Summarized by Mark O’Brien,
MS4 | Edited by John Spartz MD & Erik Verzemnieks,
In an effort to promote diversity, equity, and inclusion in
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Award. We support increasing the
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