ICU-level care-asthma-EXACERBATION

• Invasive ventilation:

Large ET tube, Pplat <30 cm H2O (predicts barotrauma better than PIP), max exp time

PEEP individualized to patient physiology

Paralysis, inhalational anesthetics, bronchoalveolar lavage w/ mucolytic, heliox (60–80% helium) and ECMO have been used with success

IV ketamine: bronchodilating effects and can be used for refractory status asthmaticus

• NPPV likely improves obstruction (Chest 2003;123:1018), but controversial and rarely used