Noninvasive ventilation in severe acute asthma

Jhaymie L. Cappiello, Michael B. Hocker

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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 SpO2 88%, heart rate 110–120 beats/min, blood pressure 220/110 mm Hg, and temperature 35.8°C. NIV at 12/5 cm H2O and FIO2 0.40 was applied, and albuterol at 40 mg/h was initiated. Admission arterial blood gas revealed a pH of 6.95, PaCO2 126 mm Hg, and PaO2 316 mm Hg. After 90 min of therapy, PaCO2 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.

Original languageEnglish (US)
Pages (from-to)e149-e152
JournalRespiratory Care
Volume59
Issue number10
DOIs
StatePublished - Oct 2014
Externally publishedYes

Keywords

  • ARF
  • Asthma
  • Capnography
  • Continuous albuterol
  • Intubation
  • Mechanical ventilation
  • Noninvasive
  • Sedation
  • Ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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