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.