Life-threatening asthma: Focus on lung protection

Abstract

Acute asthma exacerbation is a common medical emergency; approximately 10% of asthma related hospital admissions will require intensive care and, despite aggressive medical therapy, 4% will develop life-threatening asthma requiring endotracheal intubation and mechanical ventilation for persistent respiratory failure. Not surprisingly, patients with life-threatening asthma have high morbidity and mortality. In this chapter, we will review the pathophysiology of dynamic hyperinflation and respiratory failure in asthma, and armed with this knowledge we describe how to provide lung protective mechanical ventilation while delivering adequate oxygenation and maximizing medical therapy. We will also comment on the different rescue therapies available for patients with refractory respiratory failure who fail mechanical ventilation. © 2009 Springer-Verlag New York.