medigraphic.com
ISSN 1810-2352 (Print)

2012, Number 4

<< Back Next >>

Rev Cub Med Int Emerg 2012; 11 (4)

Study of asthmatic patients ventilated for four years at the University Hospital 'General Calixto Garcia'

Blanco VE, Wong VL, Chávez EJA, Ortega MLL, Sánchez LJV

Language: Spanish
References: 66
Page: 2586-2605
PDF size: 174.00 Kb.


ABSTRACT

Introduction: Mechanical ventilation has varied enormously from a rigid ventilatory protocol with pure volumetric ventilators and great use of sedatives and relaxants helping bronchodilator therapy, to more flexible schemes, with cycling ventilators equipped with great potential for monitoring and tools that make modern ventilatory support a therapeutic weapon in progressive development.
Objectives: To characterize the mechanical ventilatory pattern in patients with severe asthma exacerbation.
Methods: From January 1st 2005 to December the 31st of 2009 a retrospective and linear study was performed in the intensive care unit of the University Hospital "General Calixto Garcia" with potentially fatal asthma patients.
Results: All cases were ventilated in volume controlled mode, 32 patients were normoventilated (PCO2 between 35 and 45 mmHg) and 9 patients were ventilated with controlled hypoventilation. 29,2 % of patients had hyperacute fulminant asthma pattern with mechanical ventilation time less than 7 days and 70,7 % had severe acute pattern with mechanical ventilation time longer than 7 days.
Conclusions: The commonest mechanical ventilatory strategy applied was conventional mode. Severe acute asthma was the predominant pattern. The commonest complication and cause of death was ventilator associated pneumonia.


REFERENCES

  1. Pérez M J. Cronología de los medicamentos en el Asma. Alergia 1985; 32 (2): 37- 39.

  2. Lovesio C et al. Asma Casi Fatal. Medicina Intensiva.4ta Edición; 2002:1145-1151.

  3. M. Jiménez Lendinez, S. Yus Ternel y M. Alfageme. Servicio de Medicina Intensiva. Hospital Universitario La Paz, Madrid. [Intensivos (2008): 11.01][http://intensivos.edu/11/1101.html]

  4. Banner AS. The increase in asthma prevalence. Chest 1995;108 (2): 301-2.

  5. Mohapata SS. Ser: ¿mejor la prevención que la curación de las alergias y asma en los primeros 20 años del siguiente siglo?. Rev Alerg Mex 2001;42 (2):18-9.

  6. Buist AS, Volimer WM. Preventing deaths from asthma. N Engl Med 2004;331 (23): 1584-5.

  7. Rivero M H, Arocha R M, Gutierrez CA. Asma Bronquial. Enfoque Intensivo. Rev Cub Med Int y Emerg 2003;2 (2) 67-77.

  8. Greenberger P A. Potentially Fatal Asthma. Suppl 1993; 101: 4015-25.

  9. McFadden ER, Warren EL: Observations on asthma Mortality. Ann Intern Med 2003; 127: 142.

  10. Pepe PE, Marini JJ. Occult positive end- expiratory presurs in mechanically ventilate patients with airflow obstruction: the auto PEEP effect. Am Rev Respir Dis 2000 126:166.

  11. Buist AS, Volimer WM. Preventing deaths from asthma. N Engl Med 2004;331 (23): 1584-5.

  12. Lang DM, Polansky M. Patterns of asthma mortality in Philadelphia from 1969 to 1991. N Eng J Med 1994;331 (23): 1542-6.

  13. Abramson MJ, Mamm GB, Pattemore PK. Are non- Allergic vironmental factors important in asthma? Med J Aust 1995: 163 (10): 542-5.

  14. OPS. Estadísticas de salud en las Américas. 2005; Washington: OPS. 387p.

  15. Rodríguez de la Vega A. Simposio sobre Epidemiología Interasma 88. Habana. Cuba. Mayo2000; 3-6.

  16. Robbins. Pathologic Basis of Disease. Publicado por W.B. Saunders Company; 5ta edición (2999); pág 689-701. ISBN-10: 072167335X

  17. Asthma: What Causes Asthma. Asthma and Allergy Foundation of America. Consultado el 2008.

  18. 19.Centro para el Control y la Prevención de Enfermedades de los Estados Unidos. Datos Básicos sobre el Asma (en español). 2008

  19. Carrasco E, Feijoo R, Guzmán C, et al. Guías para el diagnóstico y manejo del asma: Recomendaciones de la Sociedad Chilena de Enfermedades Respiratorias. Revisión 2004. Rev. Chil. Enf. Respir. 2004; 20: 144-146.

  20. Institute for Clinical Systems Improvements (ICSI). Emergency and inpatient management of asthma. Bloomington (MN): Institute for Clinical systems Improvement (ICSI), 2006 Mar.

  21. Asthma. University of Michigan Health System. Asthma. Ann Arbor (MI): University of Michigan Health System; 2006.

  22. Dicpinigaitis PV. Chronic cough due to asthma: ACP evidence-based practice guidelines. Chest 2006; 129(1 Suppl):75S-9S.

  23. 24.Busquets RM, Escribano A, Fernández M, García-Marcos L, Garde J, Ibero M, y col. Consenso sobre tratamiento del asma en pediatría. An Pediatr (Barc) 2006;64:365- 78.

  24. Boushey HA, Corry DB, Fahy JV. Asthma. In: Murray JF, Nadel JA, Mason RJ, Boushey HA, eds. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: W.B. Saunders Company; 2004:1247-1289.

  25. 26.Hall JB. Status asthmaticus: ventilator management. Plenary Presentation. Programs and abstracts of CHEST 2004: 66th Annual Scientific Assembly of the American College of Chest Physicians and Clinical World Congress on Diseases of the Chest; October 22-26, 2004; San Francisco, California.

  26. Gustavo J, Rodrigo I, et al. Hospitalización por asma (1994-2004) Rev Am Resp 2009; 9: 41-48 ISSN 1852-236X ARTÎCULO ORIGINAL.

  27. Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults. A review. Chest. 2004;125:1081-102.

  28. Rodrigo GJ, Rodrigo C, Nannini LJ. Asma fatal o casi fatal: ¿entidad clínica o manejo inadecuado? Arch Bronconeumol. 2004;40:24-33.

  29. Chen Y, Stewart P, Johansen H, McRae L, Taylor G. Sex difference in hospitalization due to asthma in relation to age. J Clin Epidemiol. 2003;56:180-7.

  30. 31.Pollo JD, Guirola J, Tery R. Ventilación mecánica en el paciente asmático. Nuestra experiencia. 2004.

  31. Organización Nacional de Estadística 2006. Anuario Demográfico de Cuba. Edición 2007.

  32. Rodrigo GJ, Plaza V, Bardagi Forns S, et al. Factors associated with mortality in patients hospitalized in Spain and Latin America for acute severe asthma in 1994, 1999, and 2004. J Bras Pneumol 2008; 34: 546-551.

  33. Global Strategy for Asthma Management and Prevention. Revised 2008.

  34. Global initiative for asthma. En: www: ginasthma.com.

  35. Rodrigo G, Rodrigo C. Early prediction of poor response acute asthma patients in the emergency department. Chest 1999; 114: 1016-1021.

  36. Kellerman AL. Crisis in the emergency department. N Eng J Med 2006; 355: 1300- 1302. 38.Dellinger RP. Status asthmaticus. En: Civetta JM. Criyical care. Philadelphia: J.B. Lippincot, 1988: 1115-24.

  37. 38.Dellinger RP. Status asthmaticus. En: Civetta JM. Criyical care. Philadelphia: J.B. Lippincot, 1988: 1115-24.

  38. Sydow M, Burchardi H. Intensive care management of life-threatening status asthmaticus. Update in intensive care and emergency Medicine 1991; 14: 387-95. Edt. Springer-Verlag. 40.Menitove SM, Goldring RM. Combined ventilator and bicarbonate strategy in the management of status asthmaticus. Am J Med 1983; 74: 898-901.

  39. 40.Menitove SM, Goldring RM. Combined ventilator and bicarbonate strategy in the management of status asthmaticus. Am J Med 1983; 74: 898-901.

  40. Dellinger RP. Acute life-threatening asthma. Postgrad Med 1991; 90(3): 63-6.

  41. 42.Darioli R, Perret C. Mechanical controlled hypoventilation in status asthmaticus 1984; 129(3):385-7.

  42. Huang SG. Experiences with the aplication of mechanically controlled hypoventilation in status asthmaticus. Chung-Hua-Chieh-Ho-Ho-Hu-Hsi-Tsa-Chih. 1990;13(1):22-4.

  43. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care 2002; 165-903.

  44. Jiménez P, Torres A, Rodriguez-Risin R, de la Bellacas JP, Aznar R, Gatell JM, et al. Incidence and etiology of pneumonia acquired during mechanical ventilation. Crit Care Med 1989; 17:882-5.

  45. Branthwaite MA. An update on mechanical ventilation for severe acute asthma. Clin Intensive Care 1990;1 (1):4-6.

  46. 47.Wasserfallen JB, Schaller MD, Feihl E, Perret CH. Sudden asphixyc asthma: a distinct entity? Am Rev Respir Dis 1990;142 (1):108-11.

  47. 48.Neffen H, Baena-Cagnani C, Passalacqua G, et al. Asthma mortality, inhaled steroids, and changing asthma therapy in Argentina (1990-1999). Respir Med 2006; 100: 1431-1435.

  48. 49.NHLBI. National Asthma Education and Prevention Program. Guidelines for the diagnosis and management of asthma. Expert Panel Report-3, 2007. En: www. nhlbi.nih.gov/guidelines/asthma.

  49. 50.V. Plaza Moral, F.J. Álvarez Gutiérrez, P. Casan. Guía española para el manejo del asma. Arch Broncoeumol 2003; 39 (Supl 5): 3-42.

  50. J. Bellido, V. Plaza, S. Bardagi. ¿Disminuye la incidencia de asma de riesgo vital en España? Arch Bronconeumol 2006;42 (10):522-5.

  51. Sahn SA, Lakshminarayan RE, Petty TL. Weaning from mechanical ventilation. JAMA 1987; 235: 2208.

  52. 53.Marinelli W, Leatherman J. Sedation, paralysis, and acute myopathy. En: Hall JB, Corbridge T, Rodrigo C, Rodrigo GJ, editors. Acute asthma. Assessment and Management. New York: Mc Graw-Hill; 2000. p. 229-55.

  53. Adnet F, Dhissi G, Borron SW, Galinski M, Rayeh F, Cupa M, et al. Complication profiles of adult asthmatics requiring paralysis during mechanical ventilation. Intensive Care Med. 2001;27:1729-36.

  54. Kress JP, Pohlman AS, O'Connor MF, Hall JB. The impact of daily discontinuation of continuous sedative infusions in critically ill, mechanically ventilated patients N Engl J Med. 2000; 342:1471-7.

  55. Oliva L, Pérez CA, Guzmán N, et al. Morbilidad y mortalidad por neumonía asociada a la vantilación artificial. 2006.

  56. Jardines A, Oliva C, Romero L. Efectos adversos presentes en técnicas de ventilación artificial. 2006.

  57. Alsina Adolfo E, Raca Velázquez F. Mortalidad asociada a ventilación mecánica. Rev Sos Med Interna (Buenos Aires). (consulta: 5 agosto 2007).

  58. Gordo Vidal F, Delgado Arnaiz C, Calvo Herranz C. Lesión pulmonar inducida por la ventilación mecánica. Med Intens 2007; 31: 18-26.

  59. Ruiz CM, Guerrero PJ, Romero PC. Etiología de la neumonía asociada a la ventilación mecánica en un hospital clínico. Asociación con comorbilidad, uso previo de antimicrobianos y mortalidad. Rev Chil Infect 2007; 24 (2): 131-136.

  60. 61.D Hunter. Ventilator-associated Pneumonia. Post graduate Medical Journal 2006; 82: 172-8.

  61. Ozkurt S, Sungurtekin H, Aydemir N, Atalay H, Zencir M, Baser S, Kaleli: Ventilator Associated Pneumonia: Retrospective Results In An Intensive Care Unit. The Internet Journal of Gastroenterology 2007; 5 (2).

  62. Cunnion KM, Weber DJ, Broadhed WE, Hanson LC, Pieper CF, Rulata WA. Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J Respir Crit Care Med 1996; 153: 158-162.

  63. Kollef MH, Morrow LE, Niederman MS, Leeper KV, Anzueto A, Benz-Scott L and Rodino FJ. Clinical Characteristics and Treatment Patterns Among Patients With Ventilator- Associated Pneumonia. Chest 2006; 129: 1210-18.

  64. Division of Data Services. Asthma prevalence: health care use and mortality, 2001- 2001. Hyattsville, MD: National Center for Health Statistics; 2002.

  65. Tuxen DV, Anderson MB, Scheinkestel CD. Mechanical ventilation for severe asthma. En: Hall JB, Corbridge T, Rodrigo C, Rodrigo GJ, editors. Acute asthma. Assessment and Management. New York: McGraw-Hill; 2000. p. 209-28.

  66. Afessa B, Morales I, Cury JD. Clinical course and outcome of patients admitted to an ICU for status asthmaticus. Chest. 2001;120:1616-21.




2020     |     www.medigraphic.com