Non‐invasive ventilation use in status asthmaticus: 16 years of experience in a tertiary intensive care

Bond, Kirsten Rl; Horsley, Carl; Williams, A. B.

doi:10.1111/1742-6723.12876

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…Outro modo ventilatório utilizado na UTI foi CPAP, com programação de 10 cmH2O, com válvula PEEP conectada (BOND et al, 2017), sendo que neste modo pode ser observado melhora no aumento do PH, queda no dióxido de carbono arterial e redução do aprisionamento de ar (BOND et al, 2017).…”

Section: Discussionunclassified

Utilização Da Ventilação Mecânica Não Invasiva Durante a Crise Asmática Em Adultos

Assis¹,

Dias²,

Passos³

et al. 2023

RECIMA21

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Objetivo- Avaliar os efeitos da utilização da Ventilação Mecânica Não Invasiva (VNI) no momento da crise em adultos com asma. Métodos- Foi feita uma revisão sistemática, baseada no método Preferred Reporting Items for Systematic Reviews And Meta-Analises (PRISMA). Foram incluídos estudos clínicos randomizados, caso-controle, estudos de coorte e ensaios clínicos, escritos em português e inglês, publicados entre 2017 e 2022 no site da Biblioteca Virtual em Saúde (BVS), base de dados Physiotherapy Evidence Database (PEDro) e no portal da PubMed, por meio do uso dos descritores “asthma”, “bronchial asthma”, “noninvasive ventilation”, “bipap”, “cpap” e “bilevel”. Resultados- Ao final das buscas foram incluídos 6 estudos na presente revisão Dentre os principais resultados encontrados foi possível observar que o uso da VNI ocorreu em associação com a medicação nos pacientes durante as crises de asma, e o modo ventilatório que resultou em melhores efeitos fisiológicos foi o BIPAP (programação de IPAP de 12 cm H2O e EPAP de 8 cm H2O). A utilização do modo BIPAP em conjunto com a medicação broncodilatadora promoveu diminuição do desconforto respiratório, tempo de internação e taxas de mortalidade, desinsulflação pulmonar, melhora da oxigenação e ventilação pulmonar, redução da frequência respiratória e aumento da saturação de oxigênio nesses pacientes. Conclusão- A VNI associada a medicação broncodilatadora promoveu benefícios satisfatórios em pacientes com crises de asma, melhorando os parâmetros respiratórios e reduzindo o tempo de internação e mortalidade nesses indivíduos.

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Section: Discussionunclassified

Utilização Da Ventilação Mecânica Não Invasiva Durante a Crise Asmática Em Adultos

Assis¹,

Dias²,

Passos³

et al. 2023

RECIMA21

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“…However, patients with laterstage life-threatening or near-fatal asthma may develop hypercapnic respiratory failure, often necessitating endotracheal intubation and mechanical ventilation. Despite the lack of robust clinical evidence and guidance on using non-invasive ventilation in asthma, more recent retrospective cohort studies documented an increased frequency of NIV use [7,[57][58][59]. However, NIV failure can be associated with an increased length of hospital stay and inhospital mortality [60].…”

Section: Non-invasive Ventilation (Niv)mentioning

confidence: 99%

Management of Acute Life-Threatening Asthma Exacerbations in the Intensive Care Unit

Talbot,

Roe,

Dushianthan

2024

Applied Sciences

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Managing acute asthma exacerbations in critical care can be challenging and may lead to adverse outcomes. While standard management of an acute asthma exacerbation is well established in outpatient and emergency department settings, the management pathway for patients with life-threatening and near-fatal asthma still needs to be fully defined. The use of specific interventions such as intravenous ketamine, intravenous salbutamol, and intravenous methylxanthines, which are often used in combination to improve bronchodilation, remains a contentious issue. Additionally, although it is common in the intensive care unit setting, the use of non-invasive ventilation to avoid invasive mechanical ventilation needs further exploration. In this review, we aim to provide a comprehensive overview of the available treatments and the evidence for their use in intensive care. We highlight the ongoing need for multicentre trials to address clinical knowledge gaps and the development of intensive-care-based guidelines to provide an evidence-based approach to patient management.

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“…93,96 The risk of developing ICU-related adverse events such as diabetes, ventilator-associated pneumonia, neuro- classic, but relevant rates are poorly reported. 92,[97][98][99] In-hospital mortality rates range between 1% and 1.45% in various studies in the ward, but can reach nearly 10% in patients intubated in the ICU, 96,100,101 stressing the importance of developing new therapeutic approaches. In a twenty-year follow-up study of patients with severe asthma, 10 among 52 finally died of a fatal asthma episode despite being optimally managed.…”

Section: Epidemiology Natur Al His Tory and Tr A Jec Torie S Le Ad Ing To I Cu Admiss Ionmentioning

confidence: 99%

“…Prognosis is dominated by age and comorbidities 93,96 . The risk of developing ICU‐related adverse events such as diabetes, ventilator‐associated pneumonia, neuromyopathy, and ventilator‐associated barotrauma ultimately leading to hazardous pneumothorax and/or pneumomediastinum are classic, but relevant rates are poorly reported 92,97‐99 . In‐hospital mortality rates range between 1% and 1.45% in various studies in the ward, but can reach nearly 10% in patients intubated in the ICU, 96,100,101 stressing the importance of developing new therapeutic approaches.…”

Section: Epidemiology Natural History and Trajectories Leading To Icu...mentioning

confidence: 99%

Will the asthma revolution fostered by biologics also benefit adult ICU patients?

Bourdin

Charriot

Boissin

et al. 2020

Allergy

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Purpose: Asthma exacerbations are inflammatory events that rarely result in full hospitalization following an ER visit. Unfortunately, certain patients require prolonged support, including occasional external lung support through ECMO or ECCOR (with subsequent further exposure to other life-threatening issues), and some die. In parallel, biologics are revolutionizing severe asthma management, mostly in T2 high patients. Methods:We extensively reviewed the current unmet needs surrounding ICUadmitted asthma exacerbations, with a focus on currently available drugs and the underlying biological processes involved. We explored whether currently available T2-targeting drugs can reasonably be seen as potential players not only for relapse prevention but also as candidate drugs for a faster resolution of such episodes. The patient's perspective was also sought.Results: About 30% of asthma exacerbations admitted to the ICU do not resolve within five days. Persistent severe airway obstruction despite massive doses of corticosteroids and maximal pharmacologically induced bronchodilation is the main cause of treatment failure. Previous ICU admission is the main risk factor for such episodes and may eventually be considered as a T2 surrogate marker. Fatal asthma cases are hallmarked by poorly steroid-sensitive T2-inflammation associated with severe mucus plugging. New, fast-acting T2-targeting biologics (already used for preventing asthma exacerbations) have the potential to circumvent steroid sensitivity pathways and decrease mucus plugging. This unmet need was confirmed by patients who reported highly negative, traumatizing experiences. Conclusions:There is room for improvement in the management of ICU-admitted severe asthma episodes. Clinical trials assessing how biologics might improve ICU outcomes are direly needed.

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Non‐invasive ventilation use in status asthmaticus: 16 years of experience in a tertiary intensive care

Abstract: The use of NIV appears to be safe and effective in patients with severe asthma, including selected patients with an altered level of consciousness. NIV was well tolerated with a low need for subsequent intubation.

Cited by 12 publications

References 29 publications

Utilização Da Ventilação Mecânica Não Invasiva Durante a Crise Asmática Em Adultos

Utilização Da Ventilação Mecânica Não Invasiva Durante a Crise Asmática Em Adultos

Management of Acute Life-Threatening Asthma Exacerbations in the Intensive Care Unit

Will the asthma revolution fostered by biologics also benefit adult ICU patients?

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