Artificial respiration in patients with acute severe asthma. Mode of ventilation and survival
Toft, P.; Fisker, N.J.; Andersen, P.K.; Tønnesen, E.K.
Ugeskrift for Laeger 156(51): 7687-7692
1994
ISSN/ISBN: 0041-5782 PMID: 7839534 Document Number: 426091
The purpose of the study was to register the treatment, mode of ventilation and mortality of patients with acute severe asthma treated with intermittent positive pressure ventilation (IPPV) in a Danish intensive care unit (ICU) during a ten-year period. Fifty-seven patients underwent ventilation on 78 occasions. Fifty-three patients were ventilated with controlled hypoventilation and low PEEP, while four patients were treated with high PEEP. One of the 53 patients receiving controlled hypoventilation and two of the four patients who received high PEEP developed a pneumothorax. All the patients were treated with intravenous steroid and infusion of a beta 2-agonist. Eighty-eight point three per cent received an infusion of theophylline whereas only 16.9% were treated with inhalation of a beta 2-agonist. Eight patients already had irreversible brain damage due to cardiac arrest before arrival to the ICU. Seven of these patients died due to brain damage. All the patients who reached the ICU without brain damage survived. After discharge from the hospital increased mortality was observed among these patients. Some of the patients died due to underestimation from doctors as well as patients of the severity of the asthma. Patients with acute severe asthma requiring IPPV should be ventilated with controlled hypoventilation. A high PEEP is associated with an increased risk of barotrauma. Continuing education of doctors and patients is necessary to increase the use of objective airflow measurement.