Ventilating an Asthmatic

Albury Wodonga Health Teaching Program 2013

Source: AIHW National Hospital Morbidity Database

Asthma presentations to ED

Source: AIHW National Hospital Morbidity Database

Seasonal variation in hospital separation rates for asthma, 2007 and

2008

Source: ACAM and AIHW analysis of AIHW National Mortality Database.

Deaths from Asthma in Australia

Causes of Death in Australia

Rates of death in Australia

• Ischaemic Heart Disease

• Driving a motorbike

• Driving a car

• Having asthma

• 5-34 with asthma

0.1%

0.04%

0.005%

0.002%

0.0005%

Dynamic Hyperinflation

LungVolume

(L)

Normal TLC

Normal FRC

Normal RV

Dynamic Hyperinflation

Obstructio

n

ventilatio

n

strategy

GOAL

give them time to expire

Mode

FiO2RRVt

Flow

ZEEP

avoid badness

Mode

• volume

• assist control

• SIMV on this one

Vt

• 6-8ml/kg

• ideal body weight

• height based

Male Female1.55 53 481.60 57 531.65 62 571.70 66 621.75 71 661.80 75 711.85 80 751.90 84 80

Australian Medicines Handbook Ideal Body Weight Calculator

Flow

• the one dial you can forget!

• can increase to 80+L/min

FiO2

• 1.0 (100%)

• reduce to 40%

• aim for sats >90%

ZEEP

• don’t need peep

RR• the most important

setting

• lung protection

• 10/min or less

• I:E

• E 4-5 seconds

Permissive Hypercapnia

• CO2 60-90

• pH > 7.15

Plateau pressure

• ignore peak pressures

• plateau pressure

• <30cmH20

Anything else?

Bronchodilation

• Bronchodilation

• continue salbutamol nebs

• Magnesium

• steroids

• others - mdi, ipratropium, IV, adrenaline

• Sedation

• intubation is for respiratory fatigue

• make sure they are ‘resting’

• deep sedation with propofol

• has bronchodilating properties

• strong analgesia - morphine/fentanyl

Mode

FiO2RRVt

Flow

ZEEP

Acknowledgments:emcrit