ventilating an asthmatic
DESCRIPTION
Ventilating an Asthmatic. Albury Wodonga Health Teaching Program 2013. Asthma presentations to ED. Source: AIHW National Hospital Morbidity Database. Seasonal variation in hospital separation rates for asthma, 2007 and 2008. Source: AIHW National Hospital Morbidity Database. - PowerPoint PPT PresentationTRANSCRIPT
Ventilating an Asthmatic
Albury Wodonga Health Teaching Program 2013
Source: AIHW National Hospital Morbidity Database
Asthma presentations to ED
Source: AIHW National Hospital Morbidity Database
Seasonal variation in hospital separation rates for asthma, 2007 and
2008
Source: ACAM and AIHW analysis of AIHW National Mortality Database.
Deaths from Asthma in Australia
Causes of Death in Australia
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%
Dynamic Hyperinflation
LungVolume
(L)
Normal TLC
Normal FRC
Normal RV
Dynamic Hyperinflation
Obstructio
n
ventilatio
n
strategy
GOAL
give them time to expire
Mode
FiO2RRVt
Flow
ZEEP
avoid badness
Mode
• volume
• assist control
• SIMV on this one
Vt
• 6-8ml/kg
• ideal body weight
• height based
Male Female1.55 53 481.60 57 531.65 62 571.70 66 621.75 71 661.80 75 711.85 80 751.90 84 80
Australian Medicines Handbook Ideal Body Weight Calculator
Flow
• the one dial you can forget!
• can increase to 80+L/min
FiO2
• 1.0 (100%)
• reduce to 40%
• aim for sats >90%
ZEEP
• don’t need peep
RR• the most important
setting
• lung protection
• 10/min or less
• I:E
• E 4-5 seconds
Permissive Hypercapnia
• CO2 60-90
• pH > 7.15
Plateau pressure
• ignore peak pressures
• plateau pressure
• <30cmH20
Anything else?
Bronchodilation
• Bronchodilation
• continue salbutamol nebs
• Magnesium
• steroids
• others - mdi, ipratropium, IV, adrenaline
• Sedation
• intubation is for respiratory fatigue
• make sure they are ‘resting’
• deep sedation with propofol
• has bronchodilating properties
• strong analgesia - morphine/fentanyl
Mode
FiO2RRVt
Flow
ZEEP
Acknowledgments:emcrit