Noninvasive mechanical ventilation in asthma crisis: an alternative ventilatory therapy to endotracheal intubation

Oxygen therapy by mask venturi (OMV) in asthma crisis (AC) could not be avoided, and urgent endotracheal intubation (ETI) is the lifesave procedure recommended. Sometimes in a selected population noninvasive ventilation (NMV) may avoid ETI and his deleterious effects (barotrauma, infections, etc).

Objective

We describe our first experience in treatment of acute respiratory insufficiency in (AC). Period of study 1995-98.

Setting

Polyvalent ICU.

Subjects

MV group n = 5, ETI group n = 12, and NMV n = 8.

Material

Ventilators: Dragger Evita 2, and BiPAP ST-D (Resp, Inc).

Method

Inclusion criteria: Borg dysnea score: 5 ; respiratory rate: >30 rpm, PaO₂ <60 mm Hg (FIO₂ 0.5%). ETI: apnoea or unstable breathing pattern, or severe dysnea. Continuous cardiorespiratory monitoring.

Results

Time of NMV: 5 ± 3 h levels of IPAP: 12 ± 3 EPAP 6 ± 3 cmH₂O; Global respiratory rate: 38 ± 10; pH: 736 ± 0.02 pCO₂: 45 ± 7 mmHg paO₂: 49 ± 26 mmHg. NMV intolerant (12.5%). Complications: NMV group: skin nose lesion n = 3; ET group: neumothorax n = 2.

Conclusion

NMV in asthma crisis refractory to (OMV) is a safe alternative to ETI, and could be avoided in selected patients(50%) . Borg Dysnea score index and respiratory rate at 3 h: 38 ± 6 to 25 ± 6 rpm in NMV group are the best early clinical predictors.

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