Pulmonology
Severe asthma & chronic obstructive pulmonary disease (COPD)
Severe asthma and chronic obstructive pulmonary disease (COPD) exacerbations are among the most common causes of acute respiratory distress, often requiring urgent intervention in critical care settings. Both conditions present unique challenges in diagnosis, treatment, and ventilatory support, necessitating evidence-based strategies to improve patient outcomes.
This section covers:
- Severe asthma exacerbations, including classification, pharmacologic management, and oxygen therapy strategies.
- Life-threatening asthma, detailing advanced therapies such as mechanical ventilation, extracorporeal CO₂ removal, and inhalational anesthetics for refractory cases.
- COPD exacerbations and acute hypercapnic respiratory failure (AHRF), focusing on non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV) as key management strategies.
By implementing guideline-based approaches, including structured ventilation protocols, pharmacologic therapy, and patient monitoring, clinicians can optimize the acute management of asthma and COPD in emergency and intensive care settings.
Severe asthma
Severe asthma
Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies
Philippe Le Conte et al., Annals of Intensive Care (2019)
What’s inside
This article provides guidelines from the Société Française de Médecine d’Urgence and the Société de Réanimation de Langue Française on managing severe asthma exacerbations. It covers diagnosis, pharmacological treatments, and oxygen therapy, including non-invasive ventilation and high-flow oxygen therapy.
Why it’s relevant
Severe asthma exacerbations can lead to acute respiratory failure, requiring prompt and effective management to reduce morbidity and mortality. These guidelines offer evidence-based recommendations to improve patient outcomes.
Key focus
- Assessment of severity criteria in medical history and physical examination.
- Pharmacological treatments, including beta-2 adrenergic agonists, anticholinergic drugs, corticosteroids, and magnesium sulfate.
- Oxygen therapy strategies, emphasizing titrated oxygen regimes and considerations for non-invasive ventilation.
Takeaway
Implementing these guidelines can enhance the management of severe asthma exacerbations, leading to better patient care and outcomes.
Severe asthma
Management of life-threatening asthma in adults
David Stanley et al., Continuing Education in Anaesthesia Critical Care & Pain (2008)
What’s inside
This article provides detailed guidance on managing life-threatening asthma in adults, covering pathophysiology, diagnostic criteria, initial management, and advanced treatments. It emphasizes the importance of prompt intervention and individualized care strategies to improve patient outcomes.
Why it’s relevant
Life-threatening asthma can lead to severe complications and death if not managed properly. Early recognition and effective treatment are critical to prevent respiratory failure and improve survival rates, especially in acute exacerbations.
Key focus
- Identification and classification of asthma severity, including life-threatening and near-fatal asthma.
- Initial management strategies such as high-flow oxygen, nebulized beta-agonists, steroids, and magnesium sulfate.
- Management of mechanical ventilation, including sedation, neuromuscular blockade, and ventilator settings.
- Considerations for advanced therapies like extracorporeal CO₂ removal, bronchoscopy, and the use of inhalational anesthetics.
Takeaway
Implementing structured, evidence-based management protocols for life-threatening asthma, including careful monitoring and timely use of advanced therapies, is essential to reduce complications and improve patient outcomes.
Severe asthma
Managing Asthma Exacerbations in the Emergency Department
Carlos A. Camargo Jr. et al., Proceedings of the American Thoracic Society (2009)
What’s inside
This article summarizes the National Asthma Education and Prevention Program's Expert Panel Report 3 guidelines for managing asthma exacerbations in emergency settings.
Why it’s relevant
It provides evidence-based recommendations to improve patient outcomes during acute asthma episodes in emergency departments.
Key focus
- Assessment: Classifying exacerbation severity to guide treatment decisions.
- Treatment: Early administration of oxygen, inhaled short-acting beta2-agonists, and systemic corticosteroids.
- Monitoring: Continuous evaluation of patient response and readiness for discharge.
- Special Populations: Considerations for high-risk groups, including infants and patients with risk factors for asthma-related death.
Takeaway
Implementing these guidelines can enhance the management of asthma exacerbations in emergency departments, leading to better patient care and reduced morbidity.
Exacerbations of chronic obstructive pulmonary disease
Make sure to read the recommendations on non-invasive mechanical ventilation, as presented here.
Acute hypercapnic respiratory failure
BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults
A Craig Davidson et al., Thorax (2016)
What’s inside
This guideline provides comprehensive recommendations for the ventilatory management of acute hypercapnic respiratory failure (AHRF) in adults, focusing on both non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV).
Why it’s relevant
It offers evidence-based guidance to healthcare professionals for effectively managing AHRF, aiming to improve patient outcomes and standardize care practices.
Key focus
- Non-Invasive Ventilation (NIV): Criteria for initiation, optimal settings, and monitoring protocols.
- Invasive Mechanical Ventilation (IMV): Indications for use, ventilatory strategies, and weaning processes.
- Oxygen Therapy: Guidelines for controlled oxygen administration to achieve target saturations.
- Special Populations: Considerations for patients with conditions like COPD, neuromuscular diseases, and obesity hypoventilation syndrome.
- Care Environments: Recommendations on appropriate settings for delivering NIV and IMV, emphasizing the need for trained personnel and adequate facilities.
Takeaway
Adhering to these guidelines can enhance the management of AHRF in adults, leading to improved patient care and outcomes.