Acute severe asthma

2020 ◽  
pp. 55-66
Author(s):  
Andrew Nyman ◽  
Andrew Durward
Keyword(s):  
Severe Asthma ◽  
Airway Resistance ◽  
Acute Severe Asthma ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Risk Of Mortality ◽  
Non Invasive Ventilation ◽  
Ventilation Strategies ◽  
Outcomes For Children ◽  
Induction Of Anaesthesia

Children with acute severe asthma requiring invasive ventilation are among the most difficult to manage in the Intensive Care Unit (ICU). This chapter begins by explaining the pathophysiology of asthma before examining the approaches to its management on the ICU—starting with the evidence for the use of non-invasive ventilation and bronchodilators. Indications for invasive ventilation in acute severe asthma are discussed and important considerations in the conduct of induction of anaesthesia and intubation in this patient group. Ventilation strategies are explored, with particular reference to the concepts of airway resistance, driving pressure, inspiratory flow limitation, and auto-positive end expiratory pressure (PEEP). The use of the mucolytic therapy intratracheal DNAse is discussed, and indications for the use of extracorporeal membrane oxygenation in refractory cases. Finally, the chapter reports on outcomes for children with acute severe asthma and factors associated with higher risk of mortality.

Assessment of non-invasive ventilation in acute severe asthma patients

2020 ◽  
Author(s):  
Mohamed M. Metwally ◽  
Olfat Elshinnawy ◽  
Nermeen Abdelaleem ◽  
Walaa Mokhtar
Keyword(s):  
Severe Asthma ◽  
Acute Severe Asthma ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Asthma Patients

scholarly journals S68 Evaluation of non-invasive ventilation in management of acute severe asthma

Thorax ◽  
2010 ◽  
Vol 65 (Suppl 4) ◽  
pp. A32-A33 ◽  
Author(s):  
D. Chaudhry ◽  
M. Indora ◽  
V. Sangwan ◽  
I. P. S. Sehgal ◽  
A. Chaudhry
Keyword(s):  
Severe Asthma ◽  
Acute Severe Asthma ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Is non-invasive ventilation safe in acute severe asthma?

Respirology ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 251-257 ◽  
Author(s):  
Michael Pallin ◽  
Mark Hew ◽  
Matthew T. Naughton
Keyword(s):  
Severe Asthma ◽  
Acute Severe Asthma ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals 0866 A SYSTEMATIC REVIEW OF HEALTH OUTCOMES FOR CHILDREN WITH NEUROMUSCULAR DISORDERS USING LONG TERM NON-INVASIVE VENTILATION.

SLEEP ◽  
2017 ◽  
Vol 40 (suppl_1) ◽  
pp. A321-A322
Author(s):  
M Albalawi ◽  
M Castro-Codesa ◽  
R Featherstone ◽  
M Sebastianski ◽  
J Maclean
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Neuromuscular Disorders ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Outcomes For Children

scholarly journals Efficacy of non-invasive and invasive respiratory management strategies in adult patients with acute hypoxaemic respiratory failure: a systematic review and network meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Masaaki Sakuraya ◽  
Hiromu Okano ◽  
Tomoyuki Masuyama ◽  
Shunsuke Kimata ◽  
Satoshi Hokari
Keyword(s):  
Lower Risk ◽  
De Novo ◽  
Meta Analysis ◽  
Management Strategies ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Risk Of Mortality ◽  
Non Invasive Ventilation ◽  
Respiratory Management ◽  
Ventilation Modes

Abstract Background Although non-invasive respiratory management strategies have been implemented to avoid intubation, patients with de novo acute hypoxaemic respiratory failure (AHRF) are high risk of treatment failure. In the previous meta-analyses, the effect of non-invasive ventilation was not evaluated according to ventilation modes in those patients. Furthermore, no meta-analyses comparing non-invasive respiratory management strategies with invasive mechanical ventilation (IMV) have been reported. We performed a network meta-analysis to compare the efficacy of non-invasive ventilation according to ventilation modes with high-flow nasal oxygen (HFNO), standard oxygen therapy (SOT), and IMV in adult patients with AHRF. Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. Studies including adults with AHRF and randomized controlled trials (RCTs) comparing two different respiratory management strategies (continuous positive airway pressure (CPAP), pressure support ventilation (PSV), HFNO, SOT, or IMV) were reviewed. Results We included 25 RCTs (3,302 participants: 27 comparisons). Using SOT as the reference, CPAP (risk ratio [RR] 0.55; 95% confidence interval [CI] 0.31–0.95; very low certainty) was associated significantly with a lower risk of mortality. Compared with SOT, PSV (RR 0.81; 95% CI 0.62–1.06; low certainty) and HFNO (RR 0.90; 95% CI 0.65–1.25; very low certainty) were not associated with a significantly lower risk of mortality. Compared with IMV, no non-invasive respiratory management was associated with a significantly lower risk of mortality, although all certainties of evidence were very low. The probability of being best in reducing short-term mortality among all possible interventions was higher for CPAP, followed by PSV and HFNO; IMV and SOT were tied for the worst (surface under the cumulative ranking curve value: 93.2, 65.0, 44.1, 23.9, and 23.9, respectively). Conclusions When performing non-invasive ventilation among patients with de novo AHRF, it is important to avoid excessive tidal volume and lung injury. Although pressure support is needed for some of these patients, it should be applied with caution because this may lead to excessive tidal volume and lung injury. Trial registration protocols.io (Protocol integer ID 49375, April 23, 2021). 10.17504/protocols.io.buf7ntrn.

Comparison of three non-invasive ventilation strategies (NSIPPV/BiPAP/NCPAP) for RDS in VLBW infants

2017 ◽  
Vol 31 (21) ◽  
pp. 2832-2838 ◽  
Author(s):  
Vincenzo Salvo ◽  
Gianluca Lista ◽  
Enrica Lupo ◽  
Alberto Ricotti ◽  
Luc J. I. Zimmermann ◽  
...  
Keyword(s):  
Invasive Ventilation ◽  
Vlbw Infants ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Ventilation Strategies

Characteristics of the deventilation syndrome in COPD patients treated with non-invasive ventilation: a prospective, controlled, non-blinded study

2021 ◽  
Author(s):  
Mareike Lüthgen ◽  
Stephan Rüller ◽  
Christian Herzmann
Keyword(s):  
Side Effect ◽  
Airway Resistance ◽  
Vital Capacity ◽  
Blood Gas ◽  
Invasive Ventilation ◽  
Borg Scale ◽  
Non Invasive ◽  
Copd Patients ◽  
Non Invasive Ventilation ◽  
Blinded Study

Abstract Background Non-invasive ventilation (NIV) is a recommended treatment for COPD patients suffering from chronic hypercapnic respiratory failure. Prolonged dyspnea after mask removal in the morning, often referred to as deventilation syndrome, is a common side effect but has been poorly characterized yet. This study aimed to explore the pathomechanism, identify risk factors and possible treatment strategies for the deventilation syndrome. Methods A prospective, controlled, non-blinded study was conducted. After a night with established NIV therapy, the patients underwent spirometry, blood gas analyses and 6-minute walking tests (6MWT) directly, at two and four hours after mask removal. Dyspnea was measured by the modified Borg scale. Bodyplethysmography and health-related quality of life (HRQoL) questionnaires were used. Patients suffering from deventilation syndrome (defined as dyspnea of at least three points on the Borg scale after mask removal) were treated with non-invasive pursed lip breathing ventilation (PLBV) during the second night of the study. Results Eleven of 31 patients included (35%) met the given criteria for a deventilation syndrome. They reported significantly more dyspnea on the Borg scale directly after mask removal (mean: 7.2 ± 1.0) compared to measurement after two hours (4.8 ± 2.6; p = 0.003). Initially, mean inspiratory vital capacity was significantly reduced (VCmax: 46 ± 16%) compared to two hours later (54 ± 15%; p = 0.002), while no changes in pulse oximetry or blood gas analysis were observed. Patients who suffered from a deventilation syndrome had a significantly higher mean airway resistance (Reff: 320 ± 88.5%) than the patients in the control group (253 ± 147%; p = 0.021). They also scored significantly lower on the Severe Respiratory Insufficiency Questionnaire (SRI; mean: 37.6 ± 10.1 vs 50.6 ± 16.7, p = 0.027). After one night of ventilation in PLBV mode, mean morning dyspnea decreased significantly to 5.6 ± 2.0 compared to 7.2 ± 1.0 after established treatment (p = 0.019) and mean inspiratory vital capacity increased from 44 ± 16.0% to 48 ± 16.3 (p = 0.040). Conclusions The deventilation syndrome is a serious side effect of NIV in COPD patients, associated with lower HRQoL. Our data suggests that it is most likely caused by dynamic hyperinflation. Patients with high airway resistance are at greater risk of suffering from morning dyspnea. Ventilation in PLBV mode may prevent or improve the deventilation syndrome. Trial registration The study was registered in the German Clinical Trials Register (DRKS00016941) at 04 April 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS

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