TheAnswerPage/Hospital & Critical Care Medicine Sunday 03/14/2010 This week: Various aspects of the management of severe asthma

Asthma is a common condition affecting 5 to 10% of the US population. It is a complex syndrome with many clinical phenotypes varying from mild to acute life threatening presentations. Many patients present with asthma during their infancy, others at adult age. There are clear genetic factors (atopy) and environmental components (virus, allergens, occupational exposure) contributing to asthma. Asthma is a (mostly IgE-mediated) inflammation of both central and peripheral airways. The prevalence and mortality of asthma are both increasing for unclear reasons. Admission to an ICU represents a failure of management. Status asthmaticus is a medical emergency where appropriate management is critical

Mechanical ventilation in severe asthma is indicated when maximal medical therapy is failing to improve the patient's condition. It is not a treatment but a means of support while other therapies take effect. It may be very hazardous in inexperienced hands.

1. What are the complications with mechanical ventilation that are particularly important in asthma?
2. What would be your initial ventilatory settings?
3. How do you assess and monitor ventilation, with particular respect to avoiding barotrauma?

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