Abstract
This chapter will review the management of life-threatening airflow obstruction. Most typically, this clinical problem arises in the context of status asthmaticus (SA). Similar management problems are encountered in patients with upper airway obstruction (UAO) or, in the burn intensive care unit (ICU), inhalation injury (II). I will not discuss the entity of “acute-on-chronic respiratory failure” or exacerbation of chronic obstructive pulmonary disease (COPD) [1]. In these patients with chronic bronchitis and emphysema, airflow obstruction is a prominent component of their underlying pathophysiology, but it is also the case that other contributors to ventilatory failure are frequent, the degree of airflow obstruction is often less than in status asthmaticus, and many of their clinical abnormalities exist on a chronic and not acute basis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Schmidt G, Hall JB (1989) Acute-on-chronic respiratory failure: Assessment and management of patients with COPD in the emergent setting. JAMA 261: 3444–3453
Corbridge T, Hall JB (1996) Assessment and management of the adult with status asthmaticus: A State-of-the-Art. Am J Respir Crit Care Med (in press)
Petty TL (1989) Treat status asthmaticus three days before it occurs. J Intensive Care Med 4: 135–136
Wasserfallen JB, Schaller MD, Feihl F, Perret Ch (1990) Sudden asphyxic asthma: A distinct entity? Am Rev Respir Dis 142: 108–111
Sur S, Crotty TB, Kephart GM, et al (1993) Sudden onset fatal asthma: A distinct clinical entity with few eosinophils and relatively more neutrophils in the airway submucosa. Am Rev Respir Dis 148: 713–719
Greenberger PA, Patterson R (1988) The diagnosis of potentially fatal asthma. NER Allergy Proc 9: 147–152
Kikuchi Y, Okabe S, Tamura G, et al (1994) Chemosensitivity and perception of dyspnea in patients with a history of near fatal asthma. N Engl J Med 330: 1329–1334
Knowles G, Clark TJH (1973) Pulsus paradoxus as a valuable sign indicating severity of asthma. Lancet 2: 1356–1359
Permutt S, Wise RA (1986) Mechanical interaction of respiration and circulation. In: A Fishman (ed). Handbook of physiology. Vol 3, American Physiological Society, Williams and Wilkins, Baltimore pp 340–355
Rodrigo G, Rodrigo C (1993) Assessment of the patient with acute asthma in the emergency department: A factor analytic study. Chest 104: 1325–1328
Rodriquez-Roisin R, Ballester E, Roca J, et al (1989) Mechanisms of hypoxemia in patients with status asthmaticus requiring mechanical ventilation. Am Rev Respir Dis 139: 732–739
Mountain RD, Sahn S (1988) Clinical features and outcome in patients with acute asthma presenting with hypercapnia. Am Rev Respir Dis 138: 535–539
Gem JE, Lemanske RF (1993) Beta-adrenergic agonist therapy. Immunol Allergy Clin N Am 13: 839–860
Paterson JW, Evans RJC, Prime FJ (1971) Selectivity of bronchodilator action of salbutamol in asthmatic patients. Br J Dis Chest 65: 21–38
Idris AH, McDermott MF, Raucci JC, et al (1993) Emergency department treatment of sever asthma: Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 103: 665–672
Appel D, Kapel JP, Sherman M (1989) Epinephrine improves expiratory airflow rates in patients with asthma who do not respond to inhaled metaproterenol sulfate. J Allergy Clin Immunol 84: 90–98
Williams SJ, Winner SH, Clark TJH (1981) Comparison of inhaled and intravenous terbutaline in acute severe asthma. Thorax 36: 629–631
Salmeron S, Brochard L, Mal H, et al (1994) Nebulized versus intravenous albuterol in hypercapnic acute asthma: A multicenter, double-blind, randomized study. Am J Respir Crit Care Med 149: 1466–1470
Bloomfield P, Carmichael J, Petrie GR, et al (1979) Comparison of salbutamol given intravenously and by intermittent positive-pressure breathing in life-threatening asthma. Br Med J 1: 848–850
Lawford P, Jones BMJ, Milledge IS (1978) Comparison of intravenous and nebuIised salbutamol in initial treament of severe asthma. Br Med J 1: 84
Cheong B, Reynolds SR, Rajan G, et al (1988) Intravenous beta-agonist in severe acute asthma. Br Med J 297: 448–450
Spitzer WO, Suissa S, Ernst P, et al (1992) The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med 326: 501–506
Suissa S, Ernst P, Boivin JF (1994) A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med 149: 604–610
Benatar SR (1986) Fatal asthma. N Engl J Med 314: 423–429
McFadden ER Jr. (1993) Clinical commentary: Dosages of corticosteroids in asthma. Am Rev Respir Dis 147: 1306–1310
Bryant DH, Rogers P (1992) Effects of ipratropium bromide nebulizer solution with and without preservatives in the treatment of acute and stable asthma. Chest 102: 742–747
Fitzgerald JM (1994) A study of the efficacy and safety of nebulization therapy combining ipratropium bromide 0.5 mg with salbutamol sulphate 3.0 mg versus salbutamol sulphate 3.0 mg alone in acute asthma. Am J Respir Crit Care Med 149: A190 (Abst)
Green SM, Rothrock SG (1992) Intravenous magnesium for acute asthma: Failure to decrease emergency treatment duration or need for hospitalization. Ann Emergency Med 21: 260–265
Tiffany BR, Berk W, Todd IK, et al (1993) Magnesium bolus or infusion fails to improve expiratory flow in acute asthma exacerbations. Chest 104: 831–834
Skobeloff Em, Spivey Wh, McNamara RM, et al (1989) Intravenous magnesium sulfate·for the treatment of acute asthma in the emergency department. JAMA 262: 1210–1213
Curtis JL, Mahlmeister M, Fink JB, et al (1986) Helium oxygen gas therapy: Use and availability for the emergency treatment of inoperable airway obstruction. Chest 90: 455–457
Wood LDH, Engel P, et al (1976) Effect of gas physical properties and flow on lower pulmonary resistance. J Appl Physiol 41: 234–244
Manthous CA, Hall JB, Caputo MA, et al (1995) The effect ofheliox on pulsus paradoxus and peak flow in non-Intubated patients with severe asthma. Am J Respir Crit Care Med 151: 310–315
Melmed A, Hebb DB, Pohlman A, Walzers J, Manthous C, Hall JB (1995) The use of heliox as vehicle for β-agonist nebulization in patients with severe asthma. Am J Respir Crit Care Med 151:A269 (Abst)
Brochard L, Mancebo J, Wysocki M, et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333: 817–822
Shivaram U, Miro AM, Cash ME, et al (1993) Cardiopulmonary responses to continuous positive airway pressure in acute asthma. J Crit Care 8: 87–92
Pohlman A, Simpson K, Hall J (1994) Continuous intravenous infusions of lorazepam vs. midazolam for sedation during mechanical ventilatory support: A prospective, randomized study. Crit Car Med 22: 1241–1248
Murray MJ, DeRuyter ML, Harrison BA (1995) Opioids and benzodiazepines. Crit Care Clin 4: 849–875
Clarkson K, Power CK, O’Connell F, et al (1993) A comparative evaluation of propofol and midazolam, a sedative agents in fiberoptic bronchoscopy. Chest 104: 1029–1031
Lund N, Papdakos PJ (1995) Barbiturates, neuroleptics, and propofol for sedation. Crit Care Clin 4: 875–887
Valente JF, Anderson GI, Branson RD, et al (1994) Disadvantages of prolonged propofol sedation in the critical care unit. Crit Care Med 22: 710–712
Kress JP, O’Connor MF, Pohlman AS, et al (1996) Sedation of critically ill patients during mechanical ventilation: A comparison of propofol and midazolam. Am J Respir Crit Care Med (in press)
Corseen G, Gutierrez J, Reves JG, et al (1972) Ketamine in the anaesthetic management of asthmatic patients. Anesth Analg 51: 588–596
L’Hommedieu CS, Arens JJ (1987) The use of ketamine for the emergency intubation of patients with status asthmaticus. Ann Emerg Med 16: 568–571
Sarma VJ (1992) Use of ketamine in severe asthma. Acta Anaesth Scand 36: 106–107
Co ursin DB, Prielipp RC (1995) Use of neuromuscular blocking drugs in the critically ill patient. Crit Care Clin 4: 957–983
Douglass JA, Tuxen D, Horne M, et al (1992) Myopathy in severe asthma. Am Rev Respir Dis 146: 517–519
Fluegel W, Iber C, Davies S, et al (1994) Risk factors for acute myopathy in patients with severe asthma who require mechanical ventilation. Am J Respir Crit Care Med 149: A432 (Abst)
Manthous CA, Hall JB (1994) Administration of therapeutic aerosols to mechanically ventilated patients. Chest 106: 560–571
MacIntyre NR, Silver RM, Miller CW, et al (1985) Aerosol delivery in intubated, mechanically ventilated patients. Crit Care Med 13: 81–84
Manthous CA, Hall JB, Schmidt GA, et al (1993) Metered-dose inhaler versus nebulized albuterol in mechanically ventilated patients. Am Rev Respir Dis 148: 1567–1570
Chatila W, Hall JB, Manthous CA (1994) Treatment of bronchospasm by metered-doseinhaler albuterol via spacer in mechanically ventilated patients. Am J Respir Crit Care Med 149:A190 (Abst)
Tuxen DV, Lane S (1987) The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe airflow obstruction. Am Rev Respir Dis 136: 872
Tuxen DV, Williams TJ, Scheinkestel CD, et al (1992) Use of a measurement of pulmonary hyperinflation to control the level of mechanical ventilation in patients with severe asthma. Am Rev Respir Dis 146: 1136–1142
Williams TJ, Tuxen DV, Scheinkestel CD, et al (1992) Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. Am Rev Respir Dis 146: 607–615
Roy TM, Pruitt VL, Garner PA, et al (1992) The potential role for anesthesia in status asthmaticus. J Asthma 29: 73–77
Saulnier FF, Durocher AV, Deturck RA, et al (1990) Respiratory and hemodynamic effects of halothane in status asthmaticus. Intensive Care Med 16: 104–107
Gluck EH, Onorato DJ, Castriotta R (1990) Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis. Chest 98: 693–698
Lang DM, Simon RA, Mathison DA, et al (1991) Safety and possible efficacy offiberoptic bronchoscopy with lavage in the management of refractory asthma with mucous impaction. Ann Allergy 67: 324–330
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1996 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Hall, J.B. (1996). Management of Life-Threatening Airflow Obstruction. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine, vol 1996. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80053-5_39
Download citation
DOI: https://doi.org/10.1007/978-3-642-80053-5_39
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-60552-2
Online ISBN: 978-3-642-80053-5
eBook Packages: Springer Book Archive