Status asthmaticus: a large MICU experience

Shapiro, Janet; McLeroth, Patrick

doi:10.3109/tcic.13.2-3.89.93

Cited by 6 publications

(10 citation statements)

References 25 publications

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“…Mechanical ventilation for status asthmaticus is uncommon in the general population, and the incidence of intubation for status asthmaticus in pregnancy is unknown. In our series of 87 patients with status asthmaticus, 3 pregnant women required intubation [35].…”

Section: Status Asthmaticusmentioning

confidence: 68%

Critical Care of the Obstetric Patient

Shapiro

2006

J Intensive Care Med

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The obstetric patient poses exceptional challenges in the intensive care unit. Knowledge of the physiologic changes of pregnancy and specific pregnancy-related disorders is necessary for optimal management. Intensive care unit diagnoses may include preeclampsia, including the HELLP syndrome, pulmonary embolic disease, amniotic fluid embolism, status asthmaticus, respiratory infection, the acute respiratory distress syndrome, and sepsis. The management of mechanical ventilation is based on principles of avoiding lung injury, and hypercapnia may be tolerated even during the pregnancy. When the clinician is faced with the extraordinary instance of cardiopulmonary arrest, perimortem cesarean delivery must be considered to improve the potential for maternal and fetal survival.

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Section: Status Asthmaticusmentioning

confidence: 68%

Critical Care of the Obstetric Patient

Shapiro

2006

J Intensive Care Med

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“…This approach has been credited with a decrease in barotrauma, hemodynamic instability, and mortality. 5,13 The latter complications were mainly a result of the dynamic hyperinflation found in patients with severe asthma. Decreasing the respiratory rate and tidal volume as well as increasing the inspiratory flow rate will lead to an increase in expiratory time and will subsequently decrease the dynamic hyperinflation.…”

Section: Discussionmentioning

confidence: 99%

“…Results were compared to our previous study during the 5-year period 1995-1999 at this institution. 5 Data are presented as means AE standard deviations.…”

Section: Methodsmentioning

confidence: 99%

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Increasing severity of status asthmaticus in an urban medical intensive care unit

Elsayegh

Saito

Eden

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Life‐threatening status asthmaticus (SA) requiring intensive care is a major concern given the rising prevalence of asthma. We examined episodes of SA requiring admission to the medical intensive care unit (MICU) of an urban hospital center.METHODOLOGY:The charts of patients admitted to the MICU of an urban hospital center with a diagnosis of SA during the 5‐year period 2002–2006 were reviewed retrospectively. These results were compared with those of a previously published experience at our institution from 1995 to 1999.RESULTS:The medical records of 84 MICU admissions for SA were reviewed. There were 61 women (5 pregnant). The mean age was 44 years. Use of cigarettes or illicit drugs was found in 51% and 30%, respectively. Mechanical ventilation (MV) was required in 76% of admissions. Noninvasive ventilation was used in 10 patients. Neuromuscular blockade (NMB) was needed in 9% of admissions. The highest average PaCO2 during the first 24 hours was 67 mm Hg. Median duration of MV was 4.4 days. Six patients died, 3 of whom sustained prehospital cardiac arrest. Compared with the patients in the preceding 5‐year period, the more recent patients had greater use of illicit drug and cigarettes. Patients presented with more severe asthma, as reflected by a higher PaCO2 and an increased duration of MV.CONCLUSIONS:During the recent 5‐year period, we found a trend toward increasing severity of SA, as indicated by the degree of respiratory acidosis, need for NMB, and longer duration of MV. Access to medical care and cigarette and illicit drug use remain potential targets of primary intervention. Journal of Hospital Medicine 2008;3:206–211. © 2008 Society of Hospital Medicine.

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“…If hyperinflation and auto-PEEP were present, minute ventilation was reduced. Sedatives were required using propofol to facilitate controlled ventilation [8].…”

Section: Methodsmentioning

confidence: 99%

Impact of Intensive Care Management of Life Threatening Asthma on Feto-Maternal Outcome

Darwish¹

2014

J Women's Health Care

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Background: The pregnant patient with medical complications represents a unique challenge to the intensive care specialist and often requires the management expertise of several subspecialists. Aim: to evaluate the impact of intensive care management on the maternal and fetal outcomes in pregnant women with life threatening asthma. Patients and methods: Twenty six obstetric patients with life threatening asthma admitted to the maternal intensive care unit (MICU) of Woman′s Health Hospital during a 2-year Period from January 2010 through May 2012 were included in this study. Data collected included asthma history, ICU management, maternal and fetal outcome. Results: All patients had history of persistent asthma (mild 27%, moderate 50%, severe 13%); most were receiving inhaled β agonist and corticosteroid preparations before the life threatening attack. Five only stopped taking any medications during pregnancy. Controlled mechanical ventilation was required in 5 patients (19%). The severity of hypercapnia ranged from 48 to 82 mm Hg. Two cases had preclampsia, 2 gestational diabetes, vaginal bleeding and premature rupture of membrane in one case and preterm birth in 2 cases. Twenty two cases were delivered by C.S (85%). Conclusions: Obstetric patients with asthma are at risk for the development of life-threatening status asthmaticus, requiring MICU admission. The need for close interdisciplinary communication between obstetricians, intensivist and chest physicians to optimize maternal and fetal outcome is emphasized.

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Status asthmaticus: a large MICU experience

Cited by 6 publications

References 25 publications

Critical Care of the Obstetric Patient

Critical Care of the Obstetric Patient

Increasing severity of status asthmaticus in an urban medical intensive care unit

Impact of Intensive Care Management of Life Threatening Asthma on Feto-Maternal Outcome

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