Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma

Lim, Wei Jie; Akram, Redhuan Mohammed; Carson, Kristin; Mysore, Satya; Labiszewski, Nadina A; Wedzicha, Jadwiga A.; Rowe, Brian H.; Smith, Brian J.

doi:10.1002/14651858.cd004360.pub4

Cited by 117 publications

(53 citation statements)

References 40 publications

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“…NIV accelerates improvement in labor breathing and respiratory functions in mild-moderate asthmatic attacks and decreases the need for inhaled bronchodilators and hospitalization rates (21)(22)(23)(24). Therefore, NIV can be carefully used with close monitoring at ICUs, where emergency intubation can be handled, in carefully selected patients with life-threatening severe asthmatic attacks.…”

Section: Randomized Controlled Trialsmentioning

confidence: 99%

Noninvasive Ventilation for Severe Acute Asthmatic Attacks

Teke¹,

Yavsan²,

Uzun³

2015

JAEM

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Asthma is a chronic disease characterized by reversible airway obstruction caused by bronchial smooth muscle contraction, airway inflammation, and increased secretion. In most patients, control of disease activity is easily achieved with medical therapy. However, in a small minority, asthmatic attacks may be fatal. Some patients with severe asthmatic attacks are refractory to standard treatment, and a few of these patients have a history of severe asthmatic attacks that necessitated mechanical ventilation. In addition to the usual complications of mechanical ventilation, invasive mechanical ventilation in asthmatic patients is associated with other risks. These patients are often difficult to ventilate, have low compliance with high inspiratory pressures, and have frequent patient-ventilator asynchrony. Noninvasive ventilation (NIV) has been increasingly used to treat acute respiratory failure in the past two decades. It is now considered as standard first-line therapy in chronic obstructive pulmonary disease exacerbations and acute pulmonary edema. The increase in knowledge and experience has revived the use of NIV in asthma, which has previously been thought to be contraindicated. The purpose of this article is to review the up-to-date information on the use of NIV during severe acute asthmatic attacks. Nowadays, although sufficient data are not present to recommend the use of NIV in severe asthmatic attacks, there are some interesting and promising results about NIV. In conclusion, new well-designed studies including cases with respiratory acidosis and hypercapnia are necessary to eliminate the controversy. (JAEM 2015; 14: 30-4)

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Section: Randomized Controlled Trialsmentioning

confidence: 99%

Noninvasive Ventilation for Severe Acute Asthmatic Attacks

Teke¹,

Yavsan²,

Uzun³

2015

JAEM

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“…2 The immediate use of NIV in our case was not solely for the ventilatory support of the asthma exacerbation. Delay et al 4 7 performed a survey of emergency department physician use of NIV, and of the 89% who responded, NIV had been used for asthma (although Ͻ 10% reported its usage).…”

Section: Discussionmentioning

confidence: 70%

“…A 2012 Cochrane review on the use of NIV for severe asthma reports some promising preliminary results, but the use of NIV in this population still remains controversial due to a scarcity of larger controlled trials. 2 Acute severe asthma is characterized by severe air-flow limitations due to excessive secretions, airway inflammation, and bronchospasm. Definitive therapy includes bronchodilators, corticosteroids, and supportive care.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Ventilation in Severe Acute Asthma

Cappiello

Hocker

2014

Respir Care

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Noninvasive ventilation (NIV) in severe acute asthma is controversial but may benefit this population by preventing intubation. We report on a 35-year-old male asthma patient who presented to our emergency department via emergency medical services. The patient was responsive, diaphoretic, and breathing at 35 breaths/min on 100% oxygen with bag-mask assistance, with S pO 2 88%, heart rate 110 -120 beats/min, blood pressure 220/110 mm Hg, and temperature 35.8°C. NIV at 12/5 cm H 2 O and F IO 2 0.40 was applied, and albuterol at 40 mg/h was initiated. Admission arterial blood gas revealed a pH of 6.95, P aCO 2 126 mm Hg, and P aO 2 316 mm Hg. After 90 min of therapy, P aCO 2 was 63 mm Hg. Improvement continued, and NIV was stopped 4 h following presentation. NIV tolerance was supported with low doses of lorazepam. The patient was transferred to the ICU, moved to general care the next morning, and discharged 3 days later. We attribute our success to close monitoring in a critical care setting and the titration of lorazepam.

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“…Die Anwendung nicht-invasiver Beatmung (NIV) verringert die Intubationsrate sowie die Mortalität bei COPD [688], allerdings ist die Rolle des NIV bei Patienten mit schwerem akutem Asthma ungeklärt, da es keine ausreichenden Beweise für ihre routinemäßige Anwendung bei Asthma gibt [689]. [691].…”

Section: Nicht Invasive Beatmungunclassified