Is non-invasive ventilation safe in acute severe asthma?
OBJECTIVE
The effect of non-invasive ventilation (NIV) in acute severe asthma is unclear and there are concerns regarding its safety.


METHODS
We undertook a 5-year case-control review of mortality and morbidity associated with NIV use in acute severe asthma and compared this with asthma requiring invasive mechanical ventilation (IMV) and a control group with less severe asthma without ventilatory support.


RESULTS
Eight hundred seventy-three patients had acute severe asthma of whom 30 were treated with NIV, 17 with IMV and 90 served as controls. The mean duration of NIV was 9.5 ± 7.3 h with inspiratory positive airway pressure and expiratory positive airway pressure of 11.9 ± 1.4 and 5.8 ± 1.2 cmH2 O respectively. Mortality was zero in the NIV and control groups, compared with 41% in the IMV group. None of the NIV or control groups required escalation to invasive ventilation. There were no instances of haemodynamic compromise in the NIV or control groups. Length of hospital stay was 121 ± 96 h in the NIV group and similar to the severe IMV group (136 ± 99 h, P > 0.05) and significantly longer than the control group (42 ± 40 h, P < 0.05).


CONCLUSIONS
NIV can be safely used in acute severe asthma although further work is needed to delineate the precise patient selection process.
Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
Michael
M
Pallin
Mark
M
Hew
Matthew T
MT
Naughton
D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D045853:Exhalation; D005260:Female; D006801:Humans; D001239:Inhalation; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects* / Q000401:mortality; D011312:Pressure; D012720:Severity of Illness Index; D055815:Young Adult
asthma; mechanical ventilation; morbidity; mortality; non-invasive ventilation