Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

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Management of mechanical ventilation in acute severe asthma: practical aspects

Intensive Care Medicine ◽

10.1007/s00134-005-0045-x ◽

2006 ◽

Vol 32 (4) ◽

pp. 501-510 ◽

Cited By ~ 80

Author(s):

Mauro Oddo ◽

François Feihl ◽

Marie-Denise Schaller ◽

Claude Perret

Keyword(s):

Mechanical Ventilation ◽

Severe Asthma ◽

Acute Severe Asthma

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Safety of intravenous terbutaline in acute severe asthma: A retrospective study

Acta Paediatrica ◽

10.1111/j.1651-2227.2005.tb02077.x ◽

2007 ◽

Vol 94 (9) ◽

pp. 1214-1217 ◽

Cited By ~ 9

Author(s):

Mamatha Kambalapalli ◽

S. Nichani ◽

S. Upadhyayula

Keyword(s):

Retrospective Study ◽

Severe Asthma ◽

Acute Severe Asthma

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Helium-oxygen therapy for pediatric acute severe asthma requiring mechanical ventilation

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000074267.11280.78 ◽

2003 ◽

Vol 4 (3) ◽

pp. 353-357 ◽

Cited By ~ 28

Author(s):

Shamel A. Abd-Allah ◽

Mark S. Rogers ◽

Michael Terry ◽

Matthew Gross ◽

Ronald M. Perkin

Keyword(s):

Mechanical Ventilation ◽

Severe Asthma ◽

Oxygen Therapy ◽

Acute Severe Asthma

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Prediction of the Need for Mechanical Ventilation in Acute Severe Asthma

Respiration ◽

10.1159/000196521 ◽

1996 ◽

Vol 63 (2) ◽

pp. 73-77 ◽

Cited By ~ 2

Author(s):

A. de Diego ◽

M. Perpiñá ◽

M. León ◽

L. Compte ◽

S. Ferrandis ◽

...

Keyword(s):

Mechanical Ventilation ◽

Severe Asthma ◽

Acute Severe Asthma

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Mechanical Ventilation in Patients with Acute Severe Asthma

Survey of Anesthesiology ◽

10.1097/00132586-199108000-00044 ◽

1991 ◽

Vol 35 (4) ◽

pp. 246

Author(s):

J. K. MANSEL ◽

S. W. STOGNER ◽

M. F. PETRINI ◽

J. R. NORMAN

Keyword(s):

Mechanical Ventilation ◽

Severe Asthma ◽

Acute Severe Asthma

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Correlation of Oxygen Consumption and Patient Day with Invasive Mechanical Ventilation in a Hospital in Sao Paulo during Covid-19 Pandemic

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol06-i11/1266 ◽

2021 ◽

Vol 6 (11) ◽

pp. 835-839

Author(s):

Kaio Jia Bin ◽

Luana Alcantara Machado ◽

Nivaldo Fracacio Junior ◽

Francis Mironescu Tomazini ◽

Paula Cristina Souto De Camargo ◽

...

Keyword(s):

Mechanical Ventilation ◽

Oxygen Consumption ◽

Retrospective Study ◽

Strong Correlation ◽

Oxygen Therapy ◽

Invasive Mechanical Ventilation ◽

Single Center ◽

Billing Data ◽

Central Institute ◽

The World

Background: The new coronavirus led the world into the pandemic known as COVID-19. Still, without any effective treatment, oxygen therapy is the most used treatment for patients. Without proper management of this medicinal gas, lives can be lost for lack of it. Aim: Find an indicator of a strong correlation with oxygen consumption. Methods: A single-center retrospective study, that evaluated the oxygen consumption billing data and patient-day indicator of Central Institute of HCFMUSP between 2019 and 2020. Results: A total of 380,245 patient days were analyzed. A strong correlation was identified between oxygen consumption and patient day with invasive mechanical ventilation (0.92). An average of 41.6 (± 7.8) cubic meters per patient day with invasive mechanical ventilation was found. Conclusion: There is a strong correlation between oxygen consumption in cubic meters and patient days with invasive mechanical ventilation at the Central Institute of HCFMUSP. The average values of consumption per patient day can help in planning oxygen management in other hospitals.

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Non-invasive mechanical ventilation in patients with influenza A-associated acute respiratory distress syndrome: a retrospective study

10.22541/au.160310710.04448388/v1 ◽

2020 ◽

Author(s):

lulu chen ◽

Heng Weng ◽

Hongyan Li ◽

Xinhang Wang ◽

Hongying Zhang ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Retrospective Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Influenza A ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Non Invasive

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Acute Severe Asthma: Changes in Patient Characteristics, Management, and Outcomes over a Period of 20 Years (1997 to 2017), Insights from Cub-Réa Network.

10.21203/rs.3.rs-917409/v1 ◽

2021 ◽

Author(s):

Romy Younan ◽

Jean Loup Augy ◽

Bertrand Hermann ◽

Bertrand Guidet ◽

Philippe Aegerter ◽

...

Keyword(s):

Mechanical Ventilation ◽

Multivariate Analysis ◽

Survival Rate ◽

Severe Asthma ◽

Emergency Department Visits ◽

Adult Patients ◽

Acute Severe Asthma ◽

Icu Mortality ◽

Non Invasive ◽

Over Time

Abstract Background: While acute severe asthma (ASA) is the leading cause of emergency department visits and the third cause of hospitalization in children younger than 18 years old, there is a lack of data regarding adult patients admitted in intensive care units (ICU) for ASA. We aimed to describe the evolutions in epidemiology, management, and outcomes of ASA in adult patients, over a period of twenty years in the Greater Paris area ICUs (CUB-Réa Database). Methods: Demographics, severity and supportive treatments were collected from the CUB-Réa Database. The primary endpoint was the prevalence of ASA by periods of 5 years. The secondary endpoints were in-ICU survival, in-hospital survival, use of mechanical ventilation including non-invasive and invasive and catecholamine. Multivariate analysis was performed to assess correlating factors of ICU Mortality. Results: Of the 475 357 ICU admissions from January 1997 to January 2016, 7049 were admitted for ASA with a decreasing prevalence over time, respectively 2.8%, 1.7%, 1.1%, and 1.1% of total ICU admissions (p <0.001). The median age was 46 years old [IQR: 25%-75%: 32-59], 3906 (55%) were female, the median SAPS II was 20 [IQR: 13-28], and 1501 (21%) had mechanical ventilation. Over time, age, the SAPSII and the Charlson Comorbidity Index tended to increase. The use of invasive and non-invasive mechanical ventilation increased (p < 0.001), whereas the use of catecholamine decreased (p <0.001). The in-ICU survival rate improved from 97% to 99% (p=0.008). In the multivariate analysis, factors associated with in-ICU mortality were SAPSII (p < 0.001), renal replacement therapy (p < 0.001), catecholamine (p < 0.001), cardiac arrest (p < 0.001), pneumothorax (p < 0.001), ARDS (p < 0.001), sepsis (p < 0.001) and IMV (p < 0.001). Conclusion: ICU admission for ASA remains uncommon and decreases over time. Despite an increasing severity of patients and the use of mechanical ventilation, the use of catecholamine decreases with high in-ICU survival rate which could be related to a better management of mechanical ventilation.

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Volatile Agents to Avoid Ventilating Asthmatics

Anaesthesia and Intensive Care ◽

10.1177/0310057x0303100213 ◽

2003 ◽

Vol 31 (2) ◽

pp. 208-210 ◽

Cited By ~ 11

Author(s):

G. Baigel

Keyword(s):

Mechanical Ventilation ◽

Tracheal Intubation ◽

Medical Treatment ◽

Severe Asthma ◽

Initial Response ◽

Acute Severe Asthma ◽

Inhalational Agent ◽

The Face ◽

Spontaneously Breathing ◽

Volatile Agents

The management of six awake, spontaneously breathing patients with acute severe asthma who responded to a subanesthetic dose of an inhalational agent is described. All of these patients were on maximal medical treatment, the next intervention likely to be tracheal intubation and mechanical ventilation in the face of further deterioration. All six patients initially responded dramatically, although one required mechanical ventilation after initial response.

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