title: Use of a measurement of pulmonary hyperinflation to control the level of mechanical ventilation in patients with acute severe asthma.
abstract: Mechanical ventilation causes significant morbidity and mortality in patients with severe asthma. Hypoventilation may reduce this morbidity and mortality, but indicators to guide the degree of hypoventilation are unclear. We used a measure of pulmonary hyperinflation to assess the degree of airflow obstruction and to guide the extent and duration of hypoventilation. Ten patients who required mechanical ventilation for acute severe asthma were studied. All were sedated, paralyzed, and given an initial minute ventilation (VE) of 200 ml/kg/min. End-inspiratory lung volume (VEI) above FRC was measured from the total exhaled gas volume during 40 to 60 s of apnea. VEI was used to regulate VE to a safe level (VEsafe), irrespective of PaCO2, by reducing the rate when VEI was > 20 ml/kg and increasing it when VEI was < 20 ml/kg. Each patient was weaned when VEsafe resulted in PaCO2 < or = 40 mm Hg (the weaning point). FRC was measured computer analysis of anterior and lateral chest radiographs taken at the end of apnea. Using the weaning point criterion, 2 patients (PaCO2 < 40 mm Hg) were weaned shortly after arrival. The remaining eight (initial PaCO2, 63 +/- 17 mm Hg) continued hypoventilation until the weaning point was reached (30 +/- 29 h). The weaning point was reached by the VE required for PaCO2 40 mm Hg decreasing concurrent with the VEsafe increasing. All but 1 patient were successfully weaned within 24 h of the weaning point.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Intensive Care Unit, Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: D V
authors.initials: DV
authors.lastname: Tuxen
authors.forename: T J
authors.initials: TJ
authors.lastname: Williams
authors.forename: C D
authors.initials: CD
authors.lastname: Scheinkestel
authors.forename: D
authors.initials: D
authors.lastname: Czarny
authors.forename: G
authors.initials: G
authors.lastname: Bowes
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D000403:Airway Resistance; D001249:Asthma / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D001784:Blood Gas Analysis; D003936:Diagnosis, Computer-Assisted; D005260:Female; D005652:Functional Residual Capacity; D006801:Humans; D007321:Inspiratory Reserve Volume; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015300:Ventilator Weaning