Noninvasive Ventilation in Severe Acute Asthma

Cappiello, Jhaymie; Hocker, M.

doi:10.4187/respcare.02730

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…He received NIPPV supported by benzodiazepine in small doses to aid in his anxiety about the NIPPV mask. He cleared his PaCO 2 from 126 mmHg at presentation to 63 mmHg after 90 min and was able to be removed from NIPPV after 4 h [29]. This case demonstrates that judicious use of sedatives can facilitate NIPPV and mediate the panic associated with the face mask in some patients.…”

Section: Non-invasive Positive Pressure Ventilationmentioning

confidence: 79%

Controversies in the Care of the Acute Asthmatic in the Prehospital and Emergency Department Environments

Tennyson

2015

Curr Emerg Hosp Med Rep

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Asthma is an episodic disease of the airways characterized by inflammation and constriction of the bronchi. It has a significant societal impact with over 25 million persons affected in the United States alone and annually accounts for approximately 3300 deaths in the US. Standard therapy for acute severe asthma is effective for most patients, but controversies exist surrounding the care of the impending or actual respiratory failure patient. Non-invasive positive pressure ventilation has been effective in multiple case reports, but lacks large trial evidence to support its use. Intravenous ketamine similarly has supporting case reports, but an absence of rigorous evidence. Finally, parenteral beta-adrenergic medications have a long history of use, but have not been consistently shown to be superior to inhaled short-acting beta agonists. Further, they have been associated with higher rates of adverse effects.

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Section: Non-invasive Positive Pressure Ventilationmentioning

confidence: 79%

Controversies in the Care of the Acute Asthmatic in the Prehospital and Emergency Department Environments

Tennyson

2015

Curr Emerg Hosp Med Rep

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“…• Síntomas y signos de dificultad respiratoria aguda (disnea moderada o grave, frecuencia respiratoria incrementada para la edad, uso de músculos accesorios de la respiración y respiración paradójica). Cociente saturación transcutánea de oxígeno (SatO2)/FiO2 (S/F) (3,4) < 320 (este último criterio debe aplicarse cuando la SatO2 es menor o igual al 97% ya que en caso de ser superior pierde correlación con el P/F). • Indicación a juicio clínico del evaluador.…”

Section: B Criterios De Inicio En La Unidad De Cuidados Intermedios O...unclassified

“…Neumotórax (más frecuente en pacientes con enfermedad pulmonar bullosa), hipotensión, neumonía aspirativa, mayor desaturación y parada cardiaca por falla respiratoria hipoxémica y retardo en la intubación (3).…”

Section: D) Otras Menos Frecuentes (Complicaciones Mayores Menos Del 5%)unclassified

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Propuesta de Aplicación de un Protocolo Basado en la Evidencia de la Ventilación Mecánica no Invasiva en el Paciente Crítico

Tantaleán Da Fieno,

Rojas Galarza,

Aburto Torres

et al. 2014

Rev Peru Pediatr

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La Ventilación Mecánica No Invasiva (VMNI) es una estrategia utilizada en la atención de pacientes que requieren soporte ventilatorio, que ha venido ganando aceptación. El sistema de salud nacional presenta una demanda creciente de niños que requieren este soporte. Objetivo: Normarla aplicación y vigilancia de la VMNI en un establecimiento de salud de nivel terciario. Materiales y Métodos: Se evaluaron los estudios y documentos consultados según la escala de valoración de la evidencia y gradación de las recomendaciones recomendada por la Scottish Intercollegiate Guidelines Network (SIGN)y se plasmaron en el protocolo propuesto. Se plantearon las siguientes interrogantes: 1)¿Cuáles son las modalidades de VMNI empleadas en pediatría?; 2) ¿Cuáles son las indicaciones clínicas y/o de laboratorio para iniciar la VMNI?; 3) ¿Cuáles son las indicaciones clínicas y/o de laboratorio para iniciar la VMNI en los Servicios de Emergencia, Hospitalización y la Unidad de Cuidados Intensivos Pediátricos?; 4) ¿Durante qué tiempo y cuál es el intervalo para monitorizar si la VMNI está resultando como alternativa terapéutica?; 5) ¿Cuáles son las complicaciones de la VMNI?; 6) ¿Cuáles son los mejores predictores de éxito y de fracaso de la aplicación de la VMNI?; 7) ¿Cuáles son los mejores indicadores para monitorizar el empleo de VMNI?; 8) ¿Cuál es la conducta a seguir frente al fracaso de la VMNI?; 9) ¿Qué personal está calificado para la aplicación de la VMNI?; 10) ¿Qué personal y material es requerido para la aplicación de la VMNI?; 11) ¿Cuál es la secuencia recomendada para la aplicación de la VMNI de inicio? Resultados: Se desarrolla el protocolo y se presentan las recomendaciones graduadas según nivel de evidencia incluyendo el algoritmo y definiciones. Conclusión: Se presenta un protocolo de manejo de la ventilación mecánica no invasiva en niños, basado en la mejor evidencia disponible.

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“…Monitoring of the waveform is currently used to assess response to bronchodilators. (20,22) Prehospital indications for CPAP strongly align with those of capnography and include CHF, COPD, asthma, acute bronchitis, pneumonia, and near-drownings with signs of pulmonary edema. (23,24) Prehospital CPAP has been shown to improve patient outcomes by reducing the need for intubation (and thus decreasing the likelihood of developing ventilator-associated pneumonia),(25) improving vital signs, and reducing myocardial damage—its use is also associated with reduced mortality.…”

Section: Introductionmentioning

confidence: 99%

Integration of Capnography and Continuous Positive Airway Pressure (CPAP) in the Prehospital Setting

Sethi,

Hobbs,

Hubbard

et al. 2023

Preprint

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BACKGROUND: Capnography is one of the most important respiratory monitoring tools used in EMS because changes to end-tidal CO2 (ETCO2) generally precede blood oxygen desaturation, and waveform morphology can be used to assess bronchial patency. Many of capnography's indications overlap with those of continuous positive airway pressure (CPAP) therapy. However, there are currently no convenient methods to administer CPAP while using capnography, and no peer-reviewed studies have examined combining the two technologies in the prehospital setting. METHODS & FINDINGS: Two types of capnography sampler were used to investigate how ETCO2, capnogram shape, and respiration rate (RR) are affected by applying a CPAP mask both with and without oxygen flowing. A traditional nasal-oral cannula (NC) sampler, as well as a novel sampler that does not break the seal between the CPAP mask and the patient's face (called the CPAP-Capnography Adapter, or CCA), were evaluated on a Human Patient Simulator (HPS). No significant differences between the NC and CCA were found for ETCO2 and RR percent error. Placement of a CPAP mask without turning on O2 increased ETCO2. During CPAP therapy, the two samplers maintained their RR measurement accuracy, but ETCO2 values were significantly reduced and the capnogram depicted an increased 𝛽-angle with severe blunting of the inspiratory downstroke. CONCLUSIONS: The HPS had set-point ETCO2 and PaCO2 values, indicating that the local CO2 concentration at the nares was diluted during CPAP and no longer accurately reflected the simulated subject's breathing. The compromise in waveform morphology could be overcome by further research into interpreting capnogram differences during CPAP between healthy patients and those with respiratory pathologies. However, at this time, our results show that ETCO2 values and capnogram shape should be interpreted with caution during CPAP.

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Noninvasive Ventilation in Severe Acute Asthma

Cited by 6 publications

References 19 publications

Controversies in the Care of the Acute Asthmatic in the Prehospital and Emergency Department Environments

Controversies in the Care of the Acute Asthmatic in the Prehospital and Emergency Department Environments

Propuesta de Aplicación de un Protocolo Basado en la Evidencia de la Ventilación Mecánica no Invasiva en el Paciente Crítico

Integration of Capnography and Continuous Positive Airway Pressure (CPAP) in the Prehospital Setting

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