2000 OPEN FORUM Abstracts
SUCCESSFUL USE OF RESPIRONICS BiPAP WITH CONTINUOUS AEROSOLS FOR THE ACUTE ASTHMA PATIENT IN THE EMERGENCY DEPARTMENT: A CASE STUDY
Richard P. Bennett, BS, R.R.T., Metro Health Medical Center, Cleveland, Ohio
Introduction: This is a 32-year-old female, in acute asthma exacerbation, who was set up on non-invasive ventilation using a Respironic's BiPAP ST-D20 model in the Emergency Department. Once the patient was stabilized on the BiPAP, continuous aerosol therapy was initiated.
Case summary: The patient was admitted to the Emergency Room for asthma exacerbation. The patient had past medical history of asthma, used home medication (albuterol, atrovent, and azmacort inhalers), and history of intubation (X's 2) because of asthma. The patient was tachypneic with marked use of accessory muscles, breath sounds diminished bilaterally with both an inspiratory and expiratory wheeze, and the patient was not getting relief from intermittent aerosol therapy. The patients admitting Emergency Department arterial blood gas values on room air were; pH 7.37, PaCO2 29, PaO2 54, HCO3 16.4, O2 Sat 87%, and B.E. -7.8. The patient was placed on non-invasive ventilation per physician request with the following setting; IPAP 14 cmH2O, EPAP 4 cmH2O, Spontaneous Mode, and a 4 l/m oxygen bleed in. Continuous aerosol therapy was added in line to the BiPAP unit with continuous Albuterol (unit dose) and intermittent (Q4 hours) Atrovent (unit dose). The patient's arterial blood gas values drawn one half hour after initiation of non-invasive ventilation and continuous aerosol therapy were; pH 7.34, PaCO2 35, PaO2 91, HCO3 18.8, O2 Sat 96%, and B.E. -6.5. The patient was in the Emergency Department for approximately 4 hours on both continuous aerosol therapy and non-invasive ventilation. The patient was transported to the Medical Intensive Care Unit on just continuous aerosol therapy. The patient upon admission to the Medical Intensive Care Unit no longer required non-invasive ventilation and the continuous aerosol therapy was changed to Q2 hours Albuterol and Atrovent Q4 hours. The patient was discharged from the Medical Intensive Care Unit 8 hours later and from the hospital 6 hours after that.
Conclusion: Application of both non-invasive ventilation and continuous aerosol therapy prevented possible intubation of this patient in asthma exacerbation. The use of non-invasive ventilation and continuous aerosol therapy needs further evaluation.
Richard P. Bennett, BS, R.R.T
Respiratory Care Department, MetroHealth Medical Center
2500 MetroHealth Drive, Cleveland, Ohio 44109
Phone # (216) 778-8388 Fax # (216) 778-3240