Podcast 816: Ventilator Management in Asthmatics

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The management of severe asthma or COPD exacerbation is complex, especially when the patient requires intubation/ventilation</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Asthma is an obstructive airway disease that can cause air trapping and hyperinflation of the lungs</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">To avoid worsening hyperinflation patients typically require slower respiratory rates, lower tidal volumes, and increased expiratory time when on a ventilator</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Patients on a ventilator require very close monitoring to prevent worsening hyperinflation and associated complications including barotrauma and hypotension/cardiac arrest secondary to decreased venous return</span></li> </ul> </li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;"> </span><span style="font-weight: 400;">If patient condition starts to worsen, decrease respiratory rate and tidal volume</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;"> </span><span style="font-weight: 400;">In these cases, a decreased oxygen saturation is acceptable until their condition improves</span></li> </ul> </li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">If patient status continues to worsen, consider disconnecting the ventilator and pushing on the chest for approximately 30 seconds to help force out trapped air</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">If patient continues to decompensate, consider the possibility of a pneumothorax and determine if a ch