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Critical Care Management of Severe Asthma Exacerbations

Gayen, Shameek K.
; 
Dachert, Stephen
; 
Lashari, Bilal H.
; 
Gordon, Matthew
; 
Desai, Parag
; 
Criner, Gerard J.
; 
Cardet, Juan Carlos
; 
Shenoy, Kartik
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Genre
Journal article
Date
2024-02-01
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Temple University. Hospital
Department
Thoracic Medicine and Surgery
Subject
Asthma
 Bronchospasm
 Dynamic hyperinflation
 Extracorporeal life support
 Mechanical ventilation
 Non-invasive ventilation
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https://scholarshare.temple.edu/handle/20.500.12613/11786
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GayenEtAl-JournalArticle-2024-02.pdf
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https://doi.org/10.3390/jcm13030859
Abstract
Severe asthma exacerbations, including near-fatal asthma (NFA), have high morbidity and mortality. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Life-threatening complications of traditional ventilation strategies in asthma exacerbations include the development of systemic hypotension from hyperinflation, air trapping, and pneumothoraces. Optimizing pharmacologic techniques and ventilation strategies is crucial to treat the underlying bronchospasm. Despite optimal pharmacologic management and mechanical ventilation, the mortality rate of patients with severe asthma in intensive care units is 8%, suggesting a need for advanced non-pharmacologic therapies, including extracorporeal life support (ECLS). This review focuses on the pathophysiology of acute asthma exacerbations, ventilation management including non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV), the pharmacologic management of acute asthma, and ECLS. This review also explores additional advanced non-pharmacologic techniques and monitoring tools for the safe and effective management of critically ill adult asthmatic patients.
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Gayen, S.; Dachert, S.; Lashari, B.H.; Gordon, M.; Desai, P.; Criner, G.J.; Cardet, J.C.; Shenoy, K. Critical Care Management of Severe Asthma Exacerbations. J. Clin. Med. 2024, 13, 859. https://doi.org/10.3390/jcm13030859
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Journal of Clinical Medicine, Vol. 13, Iss. 3
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