scholarly journals Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

2019 ◽  
Vol 8 (9) ◽  
pp. 1283 ◽  
Author(s):  
Kostakou ◽  
Kaniaris ◽  
Filiou ◽  
Vasileiadis ◽  
Katsaounou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Severe Asthma ◽  
Inflammatory Disease ◽  
Respiratory Symptoms ◽  
Severe Exacerbation ◽  
Flow Variable ◽  
Acute Severe Asthma ◽  
Asthma Exacerbations

Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.

Pediatric acute asthma exacerbations: Evaluation and management from emergency department to intensive care unit

2016 ◽  
Vol 53 (6) ◽  
pp. 607-617 ◽  
Author(s):  
Brittany Pardue Jones ◽  
Geoffrey M. Fleming ◽  
Jaime Kaye Otillio ◽  
Ishan Asokan ◽  
Donald H. Arnold
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Acute Asthma ◽  
Asthma Exacerbations ◽  
Acute Asthma Exacerbations

External Chest Compression in the Management of Acute Severe Asthma—A Technique in Search of Evidence

2001 ◽  
Vol 16 (3) ◽  
pp. 124-127 ◽  
Author(s):  
Malcolm M. Fisher ◽  
Anne P. Whaley ◽  
Roger R. Pye
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Severe Asthma ◽  
Chest Compression ◽  
Sudden Onset ◽  
Prehospital Setting ◽  
Acute Severe Asthma ◽  
Anecdotal Evidence ◽  
External Chest Compression

AbstractCompelling anecdotal evidence exists for the potentially lifesaving benefits of mechanical external chest compression (MECC), but no published trials of the technique exist. The history and technique for MECC are discussed and illustrated by a case report. Although the technique is not discussed in the Resuscitation Guideline 2000, and the need for it within the intensive care unit has reduced, the use of MECC will have its greatest impact when initiated in the prehospital setting for patients suffering from severe, sudden-onset, asphyxic asthma.

The Management of Acute Severe Asthma

2001 ◽  
Vol 14 (2) ◽  
pp. 91-107 ◽  
Author(s):  
H. William Kelly
Keyword(s):  
Emergency Department ◽  
Severe Asthma ◽  
Peak Flow ◽  
Inhaled Corticosteroids ◽  
Respiratory Infections ◽  
Emergency Department Visits ◽  
Dose Inhaler ◽  
Primary Therapy ◽  
Acute Severe Asthma ◽  
Asthma Exacerbations

Acute severe asthma exacerbations resulting in emergency department visits and hospitalization usually constitute a failure of long-term control therapy. However, even patients with relatively mild asthma can have severe life-threatening episodes. In both children and adults, viral respiratory infections are the major triggering event, although outbreaks of severe asthma have been associated with high concentrations of aeroallergens. Patients should be provided with written action plans on what to do for acute deterioration, and more severe patients may keep prednisone at home to begin after consultation with their physician. The primary therapy of acute asthma exacerbations remains frequent administration of aerosol β2-agonists and systemic corticosteroids for those patients not fully responding to the β2-agonists. Mild exacerbations may be treated with an increased dosage of inhaled corticosteroids. Patients at risk for acute exacerbations may benefit from peak flow measurement, particularly those who have difficulty perceiving airway obstruction. It is recommended that patients remain on full dose of prednisone until they achieve 70-80 percent of predicted normal or personal best peak flow. In the emergency department, the use of β2-agonists by metered-dose inhaler and holding chamber is as effective as nebulizer if given in a sufficient dose 6-10 puffs equivalent to 5 mg via nebulizer. In those patients not responding completely, the addition of ipratropium bromide has shown to produce additive bronchodilation and reduce hospitalizations. Other therapies such as magnesium sulfate, intravenous β2-agonists, heliox and ketamine have been used, but data demonstrating efficacy are insufficient to warrant recommending their general use.

scholarly journals In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit after a Return Visit to the Emergency Department

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 431
Author(s):  
Chun-Fu Lin ◽  
Yi-Syun Huang ◽  
Ming-Ta Tsai ◽  
Kuan-Han Wu ◽  
Chien-Fu Lin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Regression Analysis ◽  
Intensive Care ◽  
Medical Cost ◽  
Total Medical Cost ◽  
Hospital Outcomes ◽  
Return Visit ◽  
Icu Admission ◽  
Ed Visits

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits. Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost. Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: −1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: −303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit. Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

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