Ventilating an Asthmatic

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

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

6. Causes of Death in Australia

7. 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%

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

9. Dynamic Hyperinflation

10. Obstruction ventilation strategy

11. GOAL

12. give them time to expire

13. Mode Flow RR Vt FiO2 ZEEP

14. avoid badness

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

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

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

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

19. ZEEP • don’t need peep

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

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

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

24. Anything else?

25. Bronchodilation

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

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

29. Mode Flow RR Vt FiO2 ZEEP

30. Acknowledgments:emcrit