This week we review how to ventilate the intubated asthmatic patient.
Core EM - Emergency Medicine Podcast Episode 42.0 – Ventilation in the Intubated Asthmatic
Apr 11, 2016
Explore the complexities of ventilating intubated asthmatic patients. The discussion highlights challenges such as air trapping and hyperinflation. Discover the concept of permissive hypercapnia for better exhalation. A systematic approach with the DOPS mnemonic is introduced to navigate potential complications effectively.
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Intubation Tips for Asthmatics
- Use rocuronium and ketamine for intubation in severe asthmatics due to benefits like bronchodilation.
- Use the largest endotracheal tube possible and keep the patient upright pre-intubation to reduce desaturation risk.
Challenge of Ventilating Asthmatics
- Ventilating asthmatics is difficult due to dynamic hyperinflation and air trapping leading to auto-PEEP.
- This can cause pneumothorax or decreased venous return leading to asystolic arrest if not managed.
Ventilation Strategy: Permissive Hypercapnia
- Use permissive hypercapnia by allowing a low respiratory rate to maximize exhalation time and avoid breath stacking.
- Start tidal volume 6-8 mL/kg, respiratory rate around 6-8, and increase inspiratory flow to 90-120 L/min for faster breaths and longer exhalation.