Noninvasive ventilation in severe acute asthma.
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 S(pO2) 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, P(aCO2) 126 mm Hg, and P(aO2) 316 mm Hg. After 90 min of therapy, P(aCO2) 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.
Respiratory Care Services, Duke University Hospital jhaymie.cappiello@duke.edu.
Jhaymie L
JL
Cappiello
Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina.
Michael B
MB
Hocker
D000208:Acute Disease; D000328:Adult; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D001784:Blood Gas Analysis; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*
D014151:Anti-Anxiety Agents; D008140:Lorazepam
ARF; asthma; capnography; continuous albuterol; intubation; mechanical ventilation; noninvasive; sedation; ventilation