Abstract
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 SpO2 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, PaCO2 126 mm Hg, and PaO2 316 mm Hg. After 90 min of therapy, PaCO2 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.
Original language | English |
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Pages (from-to) | e149-e152 |
Journal | Respiratory Care |
Volume | 59 |
Issue number | 10 |
DOIs | |
State | Published - Oct 2014 |
Keywords
- ARF
- Asthma
- Capnography
- Continuous albuterol
- Intubation
- Mechanical ventilation
- Noninvasive
- Sedation
- Ventilation
EGS Disciplines
- Circulatory and Respiratory Physiology
- Respiratory Therapy