scholarly journals Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review

CJEM ◽  
2007 ◽  
Vol 9 (04) ◽  
pp. 304-308 ◽  
Author(s):  
Kristopher Wiebe ◽  
Brian H. Rowe
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Acute Asthma ◽  
Treatment Options ◽  
Non Invasive ◽  
Systemic Corticosteroids ◽  
Severe Asthmatic ◽  
Nebulized Salbutamol ◽  
Life Threatening ◽  
Severe Acute Asthma

ABSTRACT Acute asthma is a common emergency department (ED) problem that is typically treated with bronchodilators and anti-inflammatories. Nebulized selective, short-acting β-agonists, such as salbutamol, are the bronchodilators of choice in most Canadian EDs. Other important treatments in moderate-to-severe cases include systemic corticosteroids and in severe cases may include the addition of ipratropium bromide and magnesium sulfate. Despite aggressive management, some patients do not respond adequately to nebulized salbutamol. Treatment options in these patients are limited to interventions such as parenteral epinephrine, and non-invasive and mechanical ventilation (or both). Both parenteral epinephrine and mechanical ventilation have associated risks, so alternative treatments with a lower risk profile would be useful for the treatment of life-threatening asthma. The following case report describes a patient in whom nebulized racemic epinephrine was used successfully to treat severe acute asthma following failure of standard first-line therapies.

scholarly journals A Loading Dose of IV Salbutamol in an Adolescent with Severe Acute Asthma and Cardiac Arrest

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Shelley A. Boeschoten ◽  
Ruben S. van der Crabben ◽  
Annemie L. M. Boehmer ◽  
Matthijs de Hoog ◽  
Corinne M. P. Buysse
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Acute Asthma ◽  
Hospital Setting ◽  
Spontaneous Circulation ◽  
Loading Dose ◽  
Severe Respiratory Distress ◽  
Systemic Corticosteroids ◽  
Life Threatening ◽  
Severe Acute Asthma

Severe acute asthma (SAA) can lead to respiratory failure and can be fatal. For rational use of intravenous (IV) bronchodilators, evidence regarding the pharmacokinetics and pharmacodynamics is lacking in children. The use of a loading dose IV salbutamol is not mentioned in any international guideline, and its use varies greatly between PICUs worldwide. We describe a 17-year-old Caucasian female with SAA resulting in an out-of-hospital cardiac arrest. After basic life support and return of spontaneous circulation, the ambulance administered oxygen, inhaled salbutamol, IV magnesium sulphate, and systemic corticosteroids. Despite of this, she was still in severe respiratory distress. Therefore, a loading dose of IV salbutamol was administered, after which an immediate improvement was observed. Having a loading dose of IV salbutamol available for emergency medical services use for SAA in children with life-threatening SAA in the out-of-hospital setting is important to consider. Further study on the dose and the effect of a loading dose IV salbutamol in children with SAA is necessary.

Mechanically Ventilating the Severe Asthmatic

2017 ◽  
Vol 33 (9) ◽  
pp. 491-501 ◽  
Author(s):  
Abdullah E. Laher ◽  
Sean K. Buchanan
Keyword(s):  
Mechanical Ventilation ◽  
Acute Asthma ◽  
Tension Pneumothorax ◽  
Pulmonary Aspiration ◽  
Dynamic Hyperinflation ◽  
Permissive Hypercapnia ◽  
Noninvasive Mechanical Ventilation ◽  
Severe Asthmatic ◽  
Severe Acute Asthma

The management of the critically ill patients with asthma can be rather challenging. Potentially devastating complications relating to this presentation include hypoxemia, worsening bronchospasm, pulmonary aspiration, tension pneumothorax, dynamic hyperinflation, hypotension, dysrhythmias, and seizures. In contrast to various other pathologies requiring mechanical ventilation, acute asthma is generally associated with better outcomes. This review serves as a practical guide to the physician managing patients with severe acute asthma requiring mechanical ventilation. In addition to specifics relating to endotracheal intubation, we also discuss the interpretation of ventilator graphics, the recommended mode of ventilation, dynamic hyperinflation, permissive hypercapnia, as well as the role of extracorporeal membrane oxygenation and noninvasive mechanical ventilation.

Severe Acute Asthma in a Pediatric Intensive Care Unit: Six Years' Experience

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 1023-1028
Author(s):  
Renato Stein ◽  
Gerard J. Canny ◽  
Desmond J. Bohn ◽  
Joseph J. Reisman ◽  
Henry Levison
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Severe Asthma ◽  
Acute Asthma ◽  
Mortality And Morbidity ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Oral Corticosteroids ◽  
Severe Acute Asthma ◽  
At Home

The management of children with severe acute asthma who required admission to the intensive care (ICU) of this hospital during 1982 to 1988 was reviewed retrospectively. A total of 89 children were admitted to the ICU on 125 occasions. During the study period, 24% of the patients were admitted to the ICU on more than one occasion. Prior to admission to this hospital, patients had been symptomatic for a mean of 48 hours. Although all patients had received bronchodilators before admission to hospital, only 23% of patients had received oral corticosteroids. According to initial arterial blood gas values determined in the ICU, 77% of the patients had hypercapnia (PaCO2 >45 mm Hg). The pharmacologic agents used in the ICU included nebulized β2agonists (100% of admissions), theophylline (99%), steroids (94%), nebulized ipratropium bromide (10%), IV albuterol (38%), and IV isoproterenol (10%). Mechanical ventilation was necessary in 33% of admissions; the mean duration of ventilation was 32 hours. Ten patients had pneumothorax; in six cases, these were related to mechanical ventilation. Three of the patients who received mechanical ventilation died, representing a mortality of 7.5%. In each of these patients, sudden, severe asthma episodes had developed at home, resulting in respiratory arrest. They had evidence of hypoxic encephalopathy at the time of admission to the ICU and eventually were declared brain dead. It was concluded that delay in seeking medical care and underuse of oral corticosteroids at home may have contributed to the need for ICU admission. The mortality and morbidity for children with severe asthma who require ICU admissions are small, provided that bronchodilators and IV steroids are used optimally and that patients who require mechanical ventilation are carefully selected.

scholarly journals Case Report: III° atrioventricular block due to fulminant myocarditis managed with non-invasive transcutaneous pacing

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 239
Author(s):  
Kiran Devkota ◽  
Ya Hong Wang ◽  
Meng Yi Liu ◽  
Yan Li ◽  
You Wei Zhang
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Atrioventricular Block ◽  
Cardiac Arrhythmias ◽  
Cardiac Pacing ◽  
Active Management ◽  
Fulminant Myocarditis ◽  
Non Invasive ◽  
Transcutaneous Pacing ◽  
Life Threatening

Fulminant myocarditis is a life-threatening clinical condition. It is the inflammation of myocardium leading to acute heart failure, cardiogenic shock and cardiac arrhythmias. Incidence of fulminant myocarditis is low and mortality is high. Most grievous complications of fulminant myocarditis is mainly cardiac arrhythmias; if there is delay on active management of the patient, it may be fatal. Here, we describe a case of III° atrioventricular block due to fulminant myocarditis that was managed with non-invasive transcutaneous cardiac pacing in the absence of ECMO. The non-invasive transcutaneous pacemaker is a safe, effective and convenient device to revert arrhythmias.

Pathophysiology and causes of airflow limitation

2016 ◽  
Author(s):  
David V. Tuxen
Keyword(s):  
Mechanical Ventilation ◽  
Tension Pneumothorax ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Dynamic Hyperinflation ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Ventilation Technique ◽  
Nebulized Salbutamol ◽  
Life Threatening

Exacerbations of asthma or chronic obstructive pulmonary disease (COPD) can be life-threatening emergencies, and require careful management to minimize the risks of morbidity and mortality. Prompt, full bronchodilator therapy, careful observation and appropriate mechanical ventilation technique is required. Dynamic hyperinflation of the lungs occurs in all patients, and must be careful assessed and regulated. Excessive dynamic hyperinflation can result in respiratory tamponade, hypotension, circulatory failure, pneumothoraces and, in severe cases, cardiac arrest. Intravenous or continuous nebulized salbutamol commonly causes lactic acidosis that should be detected and managed. Prolonged paralysis during difficult mechanical ventilation can result in severe necrotizing myopathy. Pneumothoraces in ventilated patients with asthma are usually under tension, redistribute ventilation to the contralateral lung, and risk a second tension pneumothorax. Patients surviving mechanical ventilation for asthma and COPD have an increased risk of recurrence and death. All these problems require awareness, avoidance or detection and management

scholarly journals Influenza A triggered status asthmaticus requiring emergency ECMO

2016 ◽  
Vol 73 (4) ◽  
Author(s):  
F. Guarracino ◽  
M. Stefani ◽  
P. Maremmani ◽  
M. Corini ◽  
S. Pini ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Respiratory Failure ◽  
Influenza A Virus ◽  
Influenza A ◽  
Status Asthmaticus ◽  
Severe Pneumonia ◽  
Refractory Status ◽  
Threatening Condition ◽  
Life Threatening

We describe a case of acute respiratory failure due to severe pneumonia triggered by the influenza A virus, rapidly evolving into a refractory status asthmaticus requiring emergent ECMO assistance, in order to facilitate the clinical management of patients suffering from this rare but life-threatening condition. This case report demonstrates that infection with influenza A virus can present with severe pneumonia and status asthmaticus refractory to medical and ventilatory treatment. When medical treatment and mechanical ventilation fail, extracorporeal membrane oxygenation therapy should not be delayed as it will avoid injury resulting from inadequate mechanical ventilation and lung hyperinflation.

scholarly journals Flexible bronchoscopy and mechanical ventilation in managing Mounier-Kuhn syndrome: a case report

2017 ◽  
Vol 136 (3) ◽  
pp. 266-269
Author(s):  
Aslihan Gürün Kaya ◽  
Aydin Çiledağ ◽  
Çetin Atasoy ◽  
Demet Karnak
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Acidosis ◽  
Flexible Bronchoscopy ◽  
Positive Pressure ◽  
Laboratory Findings ◽  
Non Invasive ◽  
Arterial Blood ◽  
Congenital Condition

ABSTRACT CONTEXT: Mounier-Kuhn syndrome is a rare congenital condition with distinct dilatation and diverticulation of the tracheal wall. The symptoms may vary and the treatment usually consists of support. CASE REPORT: The patient was a 60-year-old male with recurrent hospital admission. He was admitted in this case due to dyspnea, cough and sputum production. An arterial blood sample revealed decompensated respiratory acidosis with moderate hypoxemia. A chest computed tomography (CT) scan showed dilatation of the trachea and bronchi, tracheal diverticula and bronchiectasis. Flexible bronchoscopy was performed, which revealed enlarged airways with expiratory collapse. Furthermore, orifices of tracheal diverticulosis were also detected. Non-invasive positive pressure ventilation (NPPV) was added, along with long-term oxygen therapy. At control visits, the patient’s clinical and laboratory findings were found to have improved. CONCLUSION: Flexible bronchoscopy can be advocated for establishing the diagnosis and non-invasive mechanical ventilation can be used with a high success rate, for clinical wellbeing in Mounier-Kuhn syndrome.

scholarly journals “Two Stones on One Bird”: A Case Report on Severe Biphasic Anaphylaxis Masquerading as Life-Threatening Acute Asthma

2018 ◽  
Vol 6 (11) ◽  
pp. 2136-2138 ◽  
Author(s):  
Alvin Oliver Payus ◽  
Azliza Ibrahim ◽  
Norlaila Mustafa
Keyword(s):  
Case Report ◽  
Acute Asthma ◽  
Asthma Management ◽  
Symptom Improvement ◽  
Standard Management ◽  
Biphasic Reaction ◽  
Life Threatening ◽  
Initial Episode ◽  
Refractory Asthma ◽  
Observation Period

BACKGROUND: Anaphylaxis often misdiagnosed and treated as acute asthma, especially when it has a predominant respiratory symptom, and there are no obvious precipitants or previous allergic history. This morbid outcome is preventable if the level of suspicion for anaphylaxis is high among healthcare provider when treating a patient who is not responding to the standard management of acute asthma. A proportion of anaphylactic patient shows a biphasic reaction which potentially fatal when it is under-anticipated and prematurely discharge without adequate observation period after the recovery of the initial episode. CASE REPORT: Here, we present a case of a young man who has childhood asthma with the last attack more than 10 years ago presented with symptoms suggestive of acute exacerbation of bronchial asthma. As the symptoms failed to improve after standard asthma management, anaphylaxis was suspected, and he was given intramuscular adrenaline 0.5 mg which leads to symptom improvement. However, he developed another attack shortly after improvement while under observation. CONCLUSION: The objective of this case report is to emphasise the importance of keeping anaphylaxis in mind whenever a patient has treatment-refractory asthma, and also the anticipation of biphasic reaction that warrants adequate observation period especially those who are likely to have developed it.

scholarly journals Efficacy of Nebulized Magnesium Sulphate in the Treatment of Acute Bronchial Asthma Compared to Nebulized Salbutamol: A Randomized Control Trial

2020 ◽  
Vol 44 (1) ◽  
pp. 24-29
Author(s):  
Zannat Ul Sarmin ◽  
Sayeeda Anwar ◽  
Tafazzal Hossain Khan ◽  
Md Abid Hossain Mollah ◽  
Rokeya Khanam ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Acute Asthma ◽  
Treatment Options ◽  
Controlled Study ◽  
Control Group ◽  
College Hospital ◽  
Bronchodilator Effect ◽  
Nebulized Salbutamol ◽  
Asthma In Children ◽  
Group B

Background: Nebulized salbutamol is commonly used in treatment of asthma in children. The use of nebulized MgSO4 is one of the different treatment options available during acute exacerbation. Objective: To compare the efficacy of nebulized MgSO4 with nebulized salbutamol in the treatment of acute asthma in children. Materials and method: This randomized controlled study was conducted in Dhaka Medical College Hospital between January to December 2016. Children of 7-12 years with acute exacerbation of asthma were randomized into study group-A (MgSO4 group, n=30) and control group-B (Salbutamol group, n=30). Children of both groups were treated with serial nebulization thrice at 20 minute intervals by either 2.4 ml (4% MgSO4, 96 mg) or salbutamol (0.15 mg/kg minimum 2.5 mg) with 2.5 ml of isotonic normal saline. Results: The mean final PEFR were not different between the two groups (275.0±41.42 L/min in MgS04 group and 263±36.17 L/min in salbutamol group). The increase in PEF was statistically significant and comparable in both groups (by 35.1% in the MgS04 group and by 42.1% in the salbutamol group). Fischl score improvement was comparable and significant in both groups (4.31 to 0.43 in MgS04 group and 4.29 to 0.76 in salbutamol group). Statistically significant increase in oxygen saturation and reduction of heart rate was found in MgS04 group without any side effects. Nebulized MgSO4 was found having significant bronchodilator effect which is comparable to salbutamol. Conclusion: Nebulized MgS04 was found equally effective as nebulized salbutamol in the treatment of severe acute asthma in children. Bangladesh J Child Health 2020; VOL 44 (1) :24-29

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