No abstract

Asthma is a medical emergency that usually can be resolved with prompt appropriate therapy, as was well described in another article in this current edition. However, at times it is necessary to admit the patient for more aggressive therapy. At this time a good history may give clues to those who are at risk for respiratory failure. There are several physical signs and laboratory studies that may give warning to severe asthma or impending respiratory failure. For the patient who progresses into respiratory fail¬ ure, monitoring (invasive and noninvasive) is needed. As an alternative to aminophylline infusion, beta sympathomimetic agonist therapy should be considered. With signs of severe respiratory distress, intubation and mechanical ventilation with controlled peak inspiratory pressures should be employed. Our experience with using extracorporeal membrane oxygénation to treat severe airway obstruction in two infants indicates that this is a new alternative if conventional mechanical ventilation is not effective.