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Acute Asthma Exacerbations in Children: From Emergency Room to Intensive Care Unit Management

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Practical Trends in Anesthesia and Intensive Care 2019

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Abstract

Acute severe asthma induces marked alterations in respiratory mechanics, characterized by a critical limitation of expiratory flow and a heterogeneous and reversible increase in airway resistance, resulting in dynamic hyperinflation and high intrinsic PEEP. These abnormalities increase the work of breathing and can lead to life-threatening respiratory failure, in which case mechanical ventilation is life-saving.

Clinicians should keep in mind these very important pathological alterations in respiratory mechanics when caring for ventilated asthmatics. In particular, a major concern is the risk of worsening lung hyperinflation and inducing or aggravating hemodynamic instability.

We focus on the practical management of patients with acute severe asthma. Particular attention must be paid to ventilator settings, monitoring of lung hyperinflation, the role of extrinsic PEEP, and administering inhaled bronchodilators. Controlled hypoventilation with permissive hypercapnia may reduce morbidity and mortality compared to conventional normocapnic ventilation. We also underline the importance of deep sedation to maintain patient–ventilator synchrony. Finally, the role of noninvasive positive pressure ventilation for the treatment of respiratory failure during severe asthma is discussed.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, “SS Antonio e Biagio e Cesare Arrigo” Hospital, Alessandria, Italy

    Fabrizio Racca & Luigi Montagnini

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  1. Fabrizio Racca
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  2. Luigi Montagnini
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  1. San Paolo Hospital, Intensive Therapy Department, University of Milan, Milan, Italy

    Davide Chiumello

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Racca, F., Montagnini, L. (2020). Acute Asthma Exacerbations in Children: From Emergency Room to Intensive Care Unit Management. In: Chiumello, D. (eds) Practical Trends in Anesthesia and Intensive Care 2019. Springer, Cham. https://doi.org/10.1007/978-3-030-43873-9_6

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  • DOI: https://doi.org/10.1007/978-3-030-43873-9_6

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