Considerations for Mechanical Ventilation and Extubation in Status Asthmaticus

Dr. Whyte-Nesfield is a Critical Care attending at Children’s National Hospital in Washington, DC. She completed her medical degree in her home country of Grenada at St. George’s University, and her fellowship in Pediatric Critical Care at Penn State Health Children’s Hospital, PA. Mekela’s research interest is the role of parent and child traumatic stress management in improving long term outcomes of children in the PICU; she ran a multi-center prevalence study during her fellowship. She is also interested in advanced ventilator modes and educating the next generation of intensivists about pulmonary physiology.

Objectives:
After listening to this episode, listeners should be able to:

1. Define indications for intubation in a patient with asthma.
2. Review adjunct therapies, including high-dose steroids, mag, epi, terbutaline, isoproterenol, aminophylline, isoflurane, and manual decompression of the chest.
3. Identify the physiologic and logistic rationale supporting each mode of mechanical ventilation in asthma (PRVC vs PCPS).
4. Identify the benefits and risks of paralyzing an intubated asthmatic.
5.  Discuss the relationshiop between static compliance, dynamic compliance, and reversible bronchoconstriction.  
6. Describe the complications of mechanical ventilation in asthma, including indications for ECMO.

References:

1. Manual external chest compression reverses respiratory failure in children with severe air trapping. Pediatric Pulmonology, 56(12), 3887–3890. https://doi.org/10.1002/ppul.25689
2.  Mechanical ventilation of the intubated asthmatic: How much do we really know? *. Pediatric Critical Care Medicine, 5(2), 191–192. https://doi.org/10.1097/01.CCM.0000113929.14813.51
3. Volatile Anesthetic Rescue Therapy in Children With Acute Asthma. Pediatric Critical Care Medicine, 14(4), 343–350. https://doi.org/10.1097/PCC.0b013e3182772e29
4. Pressure-controlled ventilation in children with severe status asthmaticus*. Pediatric Critical Care Medicine, 5(2), 133–138. https://doi.org/10.1097/01.PCC.0000112374.68746.E8
5. Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment*. Pediatric C

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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.