Emergency medicine Australasia : EMA · 2017
Non-invasive ventilation use in status asthmaticus: 16 years of experience in a tertiary intensive care.
СтатьяНазвание и аннотация: Перевод в очереди
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Bond Kirsten Rl, Horsley Carl Ae, Williams Anthony B
Аннотация
OBJECTIVE: To describe the use of non-invasive ventilation (NIV) in adults presenting with status asthmaticus to Middlemore Hospital Critical Care Complex (CCC, South Auckland, New Zealand) from 2000 to 2015.
METHOD: Retrospective review of all adult asthma admissions to the Hospital CCC between 2000 and 2015. Demographic, physiological, treatment data and blood gas results were recorded.
RESULTS: There were 265 asthma admissions to Middlemore Hospital CCC during the study period. The median age was 34 years; 64% were female. NIV was used in 186 admissions, of which eight went on to require intubation and invasive mechanical ventilation (IMV). Twenty-three other admissions received IMV without a trial of NIV and a further 58 were managed with medical care only. The average pH for all admissions was 7.23 and the IMV group had an average pH of 6.99. Forty-five admissions presented with a Glasgow Coma Scale (GCS) score of ≤10. Twenty-five of these were managed with NIV with only one requiring subsequent intubation. The mean duration of NIV in this group was 5 h (range 1-17 h) with a mean ICU and hospital length of stay of 17 h and 3.5 days, respectively. All patients in this group effectively lowered the pCO2 over a 2 h period with NIV having an average drop of 5.9 kPa and IMV 3.4 kPa.
CONCLUSION: The use of NIV appears to be safe and effective in patients with severe asthma, including selected patients with an altered level of consciousness. NIV was well tolerated with a low need for subsequent intubation.
METHOD: Retrospective review of all adult asthma admissions to the Hospital CCC between 2000 and 2015. Demographic, physiological, treatment data and blood gas results were recorded.
RESULTS: There were 265 asthma admissions to Middlemore Hospital CCC during the study period. The median age was 34 years; 64% were female. NIV was used in 186 admissions, of which eight went on to require intubation and invasive mechanical ventilation (IMV). Twenty-three other admissions received IMV without a trial of NIV and a further 58 were managed with medical care only. The average pH for all admissions was 7.23 and the IMV group had an average pH of 6.99. Forty-five admissions presented with a Glasgow Coma Scale (GCS) score of ≤10. Twenty-five of these were managed with NIV with only one requiring subsequent intubation. The mean duration of NIV in this group was 5 h (range 1-17 h) with a mean ICU and hospital length of stay of 17 h and 3.5 days, respectively. All patients in this group effectively lowered the pCO2 over a 2 h period with NIV having an average drop of 5.9 kPa and IMV 3.4 kPa.
CONCLUSION: The use of NIV appears to be safe and effective in patients with severe asthma, including selected patients with an altered level of consciousness. NIV was well tolerated with a low need for subsequent intubation.