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Contemporary Reviews in Critical Care Medicine |

Mechanical Ventilation for Severe AsthmaMechanical Ventilation for Severe Asthma

James Leatherman, MD
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From the Division of Pulmonary and Critical Care, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN.

CORRESPONDENCE TO: James Leatherman, MD, Division of Pulmonary and Critical Care, Hennepin County Medical Cecnter, 701 Park Ave, Minneapolis, MN 55415; e-mail: James.Leatherman@hcmed.org.


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1671-1680. doi:10.1378/chest.14-1733
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Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting.

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