The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Non-Invasive Positive Pressure Ventilation in Status Asthmaticus: A Case Series in an Emergency Department

J. Brady Scott  RRT, Jhaymie L. Cappiello BS RRT,
Janice J. Thalman MHS RRT FAARC, Neil MacIntyre MD FAARC
Duke University Medical Center
Durham, NC

Background: The safe and effective use of non-invasive positive pressure ventilation (NPPV) in acute respiratory failure (ARF) from COPD is well documented. The use of NPPV in the setting of status asthmaticus (SA) is not described. The obstructive component of ARF in COPD is similar to that of SA. Therefore, we reasoned that NPPV may be useful in supporting patients in status asthmaticus

Methods:
A retrospective chart review of NPPV cases in the ED during 2005 was performed to isolate those cases of SA managed with NPPV. ARF was defined as a PaCO2 > 45mmHg and a pH< 7.30. A lack of clinical response to therapeutics and arterial blood gas analysis prompted the addition of full face mask NPPV (Respironics Vision, Carlsbad, CA). The support parameters were based on Respiratory Care Services NPPV protocol.

Results: In 2005, our emergency department (ED) treated six cases of ARF in SA (ages 29-44) in which NPPV was used in addition to conventional therapy. Mean NPPV time was 3.6 ± 2.5 hours with weaning performed by the respiratory therapist according to protocol. Mean hospital length of stay was 38 ± 34 hours. Two patients required ICU admission for < 20 hours, four cases remained in a general care ward. No case required endotracheal intubation or heliox therapy during their hospital stay. No complications were reported.

ABG Results                                                      

  Pre NPPV Post NPPV
pH 7.21 ± 0.03 7.34 ± 0.03*
PaCO2 68 ± 8 45 ± 5*
PaO2 242 ± 45 113 ± 56


(mean ± SD, *p< 0.05)

Conclusion: In the care of status asthmaticus with ARF, NPPV appears to be a safe and effective support tool to augment traditional medical management. These initial results may warrant a larger clinical trial for outcomes of SA supported with NPPV.

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