1/14. status asthmaticus treated by high-frequency oscillatory ventilation.We present a 2.5-year-old girl in severe asthma crisis who clinically deteriorated on conventional mechanical ventilation, but was successfully ventilated with high-frequency oscillatory ventilation (HFOV). Although HFOV is accepted as a technique for managing pediatric respiratory failure, its use in obstructive airway disease is generally thought to be contraindicated because of the risk of dynamic air-trapping. However, we suggest that obstructive airway disease can safely be managed with HFOV, provided certain conditions are met. These include the application of sufficiently high mean airway pressures to open and stent the airways ("an open airway strategy"), lower frequencies to overcome the greater attenuation of the oscillatory waves in the narrowed airways, permissive hypercapnia to enable reducing pressure swings as much as possible, longer expiratory times, and muscle paralysis to avoid spontaneous breathing.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/14. Mechanical ventilation during pregnancy using a helium-oxygen mixture in a patient with respiratory failure due to status asthmaticus.The authors present a 15-year-old with a second trimester intrauterine pregnancy who developed respiratory failure as the result of status asthmaticus and the development of the adult respiratory distress syndrome. Mechanical ventilation was provided with a combination of oxygen and helium to facilitate gas exchange and limit peak inflating pressures. The physiologic basis for helium's potential beneficial effects on gas exchange are reviewed. Previous reports concerning the use of helium during mechanical ventilation as well as the techniques of delivery are discussed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/14. Respiratory effects of halothane in a patient with refractory status asthmaticus.We describe the case of a 36 year old patient who was admitted to the intensive care unit (ICU) for an acute asthma attack that failed to respond to conventional treatment and required mechanical ventilation. The patient's condition improved after halothane was administered; treatment with this inhalational anaesthetic lasted 7 h, and the beneficial effect was obtained by employing concentrations between 0.5 and 2%. Under constant mechanical ventilator settings, a highly significant linear correlation between peak airway pressure and arterial pCO(2)(r: 0.98 P<0.001) was observed. The decrease in p(a)CO(2)induced by halothane may be explained by the diminished dead space that results from the drop in peak airway pressure. Arterial hypotension, which improved with inotropic agents, was the only complication that seemed related to the inhaled anaesthetic. The patient was extubated 24 h after her arrival to the ICU and discharged 72 h later. A causal relationship between the administration of halothane and clinical improvement is suggested. copyright Academic Press.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/14. Successful weaning using noninvasive positive pressure ventilation in a patient with status asthmaticus.In the treatment of severe asthma attack, acute application of non-invasive positive pressure ventilation is shown to be beneficial in some selected patients, while endotracheal intubation and mechanical ventilation is required in the remaining cases. Management with invasive ventilation in status asthmaticus is often associated with complications such as excessive mucus production and atelectasis, which may lead to prolonged hypoxemia and may increase mortality. We present a case of status asthmaticus who developed refractory atelectasis during invasive mechanical ventilation but had a dramatic resolution as well as successful weaning when non-invasive positive pressure ventilation was instituted.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
5/14. halothane, an effective infrequently used drug, in the treatment of pediatric status asthmaticus: a case report.Asthma is the most common chronic disease of childhood. Despite a better understanding of the disease process and its management, status asthmaticus continues to be a life-threatening event. The use of volatile inhaled anesthetics is infrequently reported as adjunctive therapy to conventional treatment of this condition. We report the use of halothane in a mechanically ventilated pediatric patient with life-threatening status asthmaticus who was admitted to the pediatric intensive care unit (PICU) after failing to respond to standard medical therapy and noninvasive positive pressure ventilation. A 12-year-old African American male was seen in the emergency department and treated with intravenous corticosteroids, beta-agonist therapy. He deteriorated rapidly and required endotracheal intubation and mechanical ventilation. Two hours later, the patient developed an acute, severe respiratory acidosis (pH=6.97, PaCO2=171, PaO2=162, BE=1.7). halothane was started at 2% by using the Siemens Servo 900C anesthesia ventilator. Improvement in both arterial blood gases and exhaled tidal volume were noted 30 minutes after initiation of the anesthetic gas. The patient remained on halothane for a total of 36 hours. No adverse effects associated with the use of halothane were noted. The patient was extubated to BiPAP 16/6, FiO2=0.30 at 68 hours and was discharged home 5 days later.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/14. Pressure-flow signatures of central-airway mucus plugging.SETTING: Medical intensive care Unit of Regions Hospital, a University of minnesota-affiliated teaching hospital. PATIENT: Mechanically ventilated woman with status asthmaticus and acute respiratory failure. INTERVENTION: Observations of airway pressure and flow tracings before and after bronchoscopic inspection and airway lavage. MAIN RESULTS: Four newly observed signs were recorded that may serve to identify occult central airway mucus plugging in the ventilated asthmatic patient.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/14. Cardiac asthma presenting as status asthmaticus: deleterious effect of epinephrine therapy.epinephrine is a potent bronchodilator currently used to treat severe asthma, although there is no proven advantage of this drug over beta 2 adrenergic agonists. By contrast, as demonstrated here, the use of such a potent vasoconstrictor can worsen hemodynamic status when left ventricular dysfunction is associated with asthma or is the cause for dyspnea. We describe the case of a 60-year-old man with an history of chronic asthmatic bronchitis admitted for status asthmaticus. Bronchodilator therapy, including high dosages of intravenous epinephrine, failed to improve the patient and he was intubated and mechanically ventilated. Several hours later, a right heart catheterization revealed severe unexpected left heart dysfunction with a capillary wedge pressure of 45 mmHg and a cardiac index of 1.7 l/min/m2. epinephrine was gradually stopped which resulted in a decrease in mean arterial blood pressure and an improvement of hemodynamic status. He was discharged on home mechanical ventilation. In this patient, ischemic left heart failure was revealed by a clinical picture mimicking status asthmaticus. epinephrine, given as bronchodilator therapy on an empiric basis precipitated the patient into cardiogenic shock. Therefore this drug should not be recommended in face of the possibility of cardiac asthma or associated cardiac dysfunction.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/14. Prolonged isoflurane anesthesia in status asthmaticus.We report a case of status asthmaticus that was unresponsive to the usual agents. The use of an inhalational anesthetic agent allowed us to ventilate the patient with lower inspiratory pressures; however, lasting improvement did not occur until she mobilized large quantities of secretions. To our knowledge, this is the first clinical report on the use of isoflurane anesthesia to treat severe asthma. Despite prolonged administration, there were no significant side-effects. This case demonstrates both the benefits and limitations of such therapy.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/14. The use of halothane in the treatment of status asthmaticus.The case is presented of a 39-year-old male in status asthmaticus who failed to respond to conventional therapy, including positive pressure ventilation, and who required halothane anesthesia. The urgent need to reduce his elevated airway pressure and his risk of barotrauma prompted this action. The patient's response was prompt with marked reductions in airway pressure. Discontinuing halothane resulted in rises in airway pressure, necessitating reinstitution of halothane on several occasions. The mechanism of the bronchodilating action of halothane, as well as potential interactions with other pharmacotherapy and precautions for its use, are described.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/14. High-dose intravenous magnesium sulfate in the management of life-threatening status asthmaticus.In severe status asthmaticus basic medical treatment often fails to improve the patient's condition. Mechanical ventilation in this situation is associated with a high incidence of serious complications. After the bronchodilating effect of moderate-dose magnesium sulfate in asthmatic patients had been demonstrated in previous studies we treated five mechanically ventilated patients with refractory status asthmaticus successfully with high dosages of MgSO4 IV (10-20 g within 1 h depending on the bronchodilating effect). MgSO4 resulted in a significant decrease of peak airway pressure (43.0 /- 6.8 to 32.0 /- 8.0 cmH2O) and inspiratory flow resistance (22.7 /- 7.0 to 11.9 /- 6.0 cmH2O.l-1.s-1) within 1 h. The resulting serum magnesium levels after one hour were up to threefold of the normal serum levels. Although a maintainance dose of 0.4 g/h had been administered continuously during the following 24 h serum magnesium decreased towards normal values within this time. The only relevant side-effect was a mild to moderate arterial hypotension in two of the five patients during the high dose administration period of MgSO4 which responded readily to dopamine treatment.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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