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Asthma Teaching Program for Ventilating an Asthmatic

Learn about asthma presentations to Emergency Department, seasonal variations, deaths in Australia, and dynamic hyperinflation. Master bronchodilation techniques, sedation, and ventilation strategies. Acknowledgments to emcrit.

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Asthma Teaching Program for Ventilating an Asthmatic

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  1. Ventilating an Asthmatic • Albury Wodonga Health Teaching Program 2013

  2. Asthma presentations to ED Source: AIHW National Hospital Morbidity Database

  3. Seasonal variation in hospital separation rates for asthma, 2007 and 2008 Source: AIHW National Hospital Morbidity Database

  4. Deaths from Asthma in Australia Source: ACAM and AIHW analysis of AIHW National Mortality Database.

  5. Causes of Death in Australia

  6. 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%

  7. Dynamic Hyperinflation Normal TLC Lung Volume (L) Normal FRC Normal RV

  8. Dynamic Hyperinflation

  9. Obstruction ventilation strategy

  10. GOAL

  11. give them time to expire

  12. Mode Flow RR Vt FiO2 ZEEP

  13. avoid badness

  14. Mode • volume • assist control • SIMV on this one

  15. Vt • 6-8ml/kg • ideal body weight • height based Australian Medicines Handbook Ideal Body Weight Calculator

  16. Flow • the one dial you can forget! • can increase to 80+L/min

  17. FiO2 • 1.0 (100%) • reduce to 40% • aim for sats >90%

  18. ZEEP • don’t need peep

  19. RR • the most important setting • lung protection • 10/min or less • I:E • E 4-5 seconds

  20. Permissive Hypercapnia • CO2 60-90 • pH > 7.15

  21. Plateau pressure • ignore peak pressures • plateau pressure • <30cmH20

  22. Anything else?

  23. Bronchodilation

  24. Bronchodilation • continue salbutamol nebs • Magnesium • steroids • others - mdi, ipratropium, IV, adrenaline

  25. Sedation • intubation is for respiratory fatigue • make sure they are ‘resting’ • deep sedation with propofol • has bronchodilating properties • strong analgesia - morphine/fentanyl

  26. Mode Flow RR Vt FiO2 ZEEP

  27. Acknowledgments:emcrit

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