Asthma is a respiratory disease that is characterized by reversible airway obstruction. The obstruction of the airway is caused by a triad of bronchial smooth muscle contraction, airway inflammation and increased secretions. The disease can be controlled and managed in most patients but it can also be fatal in a small minority (Landry, Foran & Koyfman 2013). Those who have severe asthmatic attacks require mechanical ventilation.
Acute respiratory failure due to exacerbation of asthma can be managed through the use of non invasive ventilation. With timely respiratory support in the form of non invasive positive pressure ventilation, complications of acute respiratory failure can be avoided. However reports on the use of this procedure on asthmatic attacks are rare. Therefore its use in asthmatic attack is still controversial. In this report, available evidence on the application of non invasive positive pressure ventilation in asthma will be reviewed. Recommendations will also be made based on the available evidence.
Care of asthmatic patients with acute respiratory failure due to exacerbation of asthma can be managed by non invasive ventilation. Invasive mechanical ventilation is also used though it is a challenge. This is because of the high risks involved due to complications such as barotrauma, weakness of the muscle, nosocomical infections, prolonged hospital stay and increased mortality (Afessa, Morales & Cury 2001). These patients are usually not easy to ventilate, they have low compliance with high inspiratory pressures and have recurrent patient ventilator asynchrony (Oddo et al. 2006). The application of this procedure should also be an act of last resort. Nevertheless, invasive ventilation should be applied without del...
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...umothorax. Unintentional application of extrinsic positive end expiratory pressure that is higher than auto positive end expiratory pressure could contribute to further dynamic hyperinflation. Combined hypovolaemia and excessively extrinsic positive end expiratory pressure may decrease venous return therefore subjecting the patient to the risk of haemodynamic compromise. Due to the risks involved in the application of this procedure, it should be applied in an intensive care unit environment by experienced personnel.
Conclusion
The use of non invasive ventilation has a direct bronchodilating effect, recruits collapsed alveoli, improve ventilation, offsets intrinsic positive end expiratory pressure and reduce the work of breathing. However, non invasive ventilation should be applied in select patients who have or are at risk of a severe asthmatic attack.
BiPAP is a form of noninvasive mechanical ventilation used on patients that have acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators however when used incorrectly, negative outcomes or not changes at all are always possible.
A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.
Facilitating spontaneous ventilation during APRV aids in alveolar recruitment, and improves distribution of lung volume to collapsed lung units. In one year retrospective study, APRV was compeered with pressure support ventilation(PSV) in eighteen patients with ALI and ARDS. Pressure support ventilation is a patient triggered, pressure limited, and flow cycled ventilation, it allows the patient to control the rate and depth of each breath. The effectiveness of spontaneous ventilation was investigated by the use of both computed tomography scan and volumetry for a period of three days.6 This study showed superiority of APRV in providing better gas distribution, pulmonary oxygenation, and decreasing lungs atelectasis faster than PSV. The clinicians recorded the main reason for this finding was derived from alveolar recruitment without overdistention during APRV. Airway Pressure Released Ventilation allows spontaneous ventilation while providing an open lung protective strategy. 6 Dr. Varpula and colleagues also compared APRV with other forms of partial mechanical ventilation, SIMV with PS, to study the effect of spontaneous ventilation in improving gas distribution. They observed no differences in clinical outcome between APRV and SIMV in gas distribution. Authors interpreted the finding due to the long study period and the differences
In conclusion, early diagnosis followed by an appropriate airway intervention is essential to prevent cardiac arrest or irreversible brain damage that occurs within minutes of complete airway obstruction. Although the conventional techniques remains standard option, every physician has to be familiar with the process of evaluating a difficult airway and, in the event of the unanticipated difficult airway and be able to use a wide variety of techniques to avoid complications and fatality. Airway management of the patient requires a coordinated effort from other consultants or colleagues, if available, can be the key to success in some circumstances.
Wildgruber and Rummeny (2012) define tension pneumothorax is a life-threatening condition where air enters the pleural cavity during inspiration but cannot escape during expiration. It is more common in patients with chest traumas and those with mechanical ventilations (Briggs, 2010). Increased the thoracic pressure will compress against the heart and the unaffected lung impairing cardiac functions and ventilation (Pons, & National Association of Emergency Medical Technicians, 2011). Rapid intervention is required to prevent fatal conditions include hypoxia, shock, cardiorespiratory arrest and death (Wildgruber & Rummeny, 2012; Day, 2011; Bethel, 2008).
It’s not an easy task to determine whether or not early tracheostomy or weaning mechanical ventilation is performed. As the healthcare team works in collaboration with each other, the patient’s best interest is carefully evaluated to ensure the best overall outcome for the particular patient. Having a knowledge base of what currents trends are regarding quality of life status post tracheostomy placement versus potential complications, must be part of the decision process by all parties involved. One the other hand, weaning a patient from mechanical ventilation, must be done in a safe and timely fashion, as other complications are seen from prolonged life support measures.
Secondly, severe asthma can be life-threatening. Suffering from asthma can be frightening to experience and people often feel scared and anxious. The fear and scare can also lead to breathlessness and so mak...
Asthma is chronic inflammatory disorder of the airways characterized by recurring episodes of wheeling and breathlessness. It often exists with allergies and can be worsened through exposure to allergens. In fact, asthma is complicated syndromes that have neither single definition nor complete explanation to the point. In light of its treatment, it is worthwhile to notice that asthma cannot be cured, instead can be only managed by avoiding exposure to allergens and/or by using medications regularly.
Marini, J. (2013). Mechanical ventilation: past lessons and the near future. Critical Care (London, England), 17 Suppl 1S1. doi:10.1186/cc11499
The signs and symptoms of respiratory distress can be presented clinically as hypoxemia which characterized as a po2 below 50 mmHg and hypercapnia which is an excessive CO2 level in the bloodstream above 45 mmHg. The signs that will manifest on the patient are dyspnea, hyperpnea, intercostal retractions, and cyanosis on digitals. The patient will present anxious and restless and if deteriorate he can be altered. Children can present with the same symptoms along with nasal flaring, retractions, grunting and irritable and later lethargic as he deteriorates his level of consciousness. Nursing interventions include to monitor patient and protect the airway along with preparing for an oral airway insertion or a tracheostomy. Essential interventions may also include raising the head of the bed, suctioning present secretions, monitoring lung sounds for a pneumothorax, monitoring the respiratory effort and depending on the situation we can provide emotional support to decrease the level of anxiety in order to help the patient not work against the o2 delivery method and maximize the
Ventilator-associated pneumonia (VAP) remains to be a common and potentially serious complication of ventilator care often confronted within an intensive care unit (ICU). Ventilated and intubated patients present ICU physicians, nurses, and respiratory therapists with the unique challenge to integrate evidence-informed practices surrounding the delivery of high quality care that will decrease its occurrence and frequency. Mechanical intubation negates effective cough reflexes and hampers mucociliary clearance of secretions, which cause leakage and microaspiration of virulent bacteria into the lungs. VAP is the most frequent cause of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden with its increased morbidity, mortality, longer ventilator days and hospital stay, and escalating health care cost.
Difficulty in airway management is considered a major cause of morbidity and mortality in anaesthesia. Hence it is important to identify patients at risk for tracheal intubation in an otherwise apparently normal airway. Difficult airway is defined as clinical situation in which a trained anaesthesiologist has difficulty with mask ventilation, tracheal intubation, or both.
The ventilator discontinuance process is one of the most important components of overall management of ventilator patients. In these cases, the clinician must balance between the patient’s capabilities and the patient’s demands. When the demands of the patient outweigh the capabilities of the patient, mechanical ventilation needs to be sustained and when the capabilities of the patient outweigh the demands of the patient, discontinuation of mechanical ventilation is possible. The role of the respiratory therapist in this decision to discontinue ventilator support is very important as many complications can be incurred if the patient is removed from ventilator support before the patient is ready or if the patient is left on the ventilator longer than necessary. These complications, along with the guidelines for ventilator discontinuance and protocol, will be discussed in this paper.
Most of you may not think of asthma as a killer disease, yet more that 5,000 Americans die of asthma each year. According to the Mayo Clinic web page, asthma also accounts for more that 400,000 hospital discharges annually. As the number of people with asthma increases, the more likely you are to come in contact with a person who has the disease. As far as I can remember, I have had asthma my whole life. My mother and one of my sisters also have asthma, so I have a first hand experience with it. This morning, I will discuss some interesting facts about asthma, I will specifically focus on what it is, warning signs, symptoms, causes, and the treatments that are used.
Nursing Diagnosis I for Patient R.M. is ineffective airway clearance related to retained secretions. This is evidenced by a weak unproductive cough and by both objective and subjective data. Objective data includes diagnosis of pneumonia, functional decline, and dyspnea. Subjective data include the patient’s complaints of feeling short of breath, even with assistance with basic ADLs. This is a crucial nursing diagnosis as pneumonia is a serious condition that is the eighth leading cause of death in the United States and the number one cause of death from infectious diseases (Lemon, & Burke, 2011). It is vital to keep the airway clear of the mucus that may be produced from the inflammatory response of pneumonia. This care plan is increasingly important because of R.M.'s state of functional decline; he is unable to perform ADL and to elicit a strong cough by himself due to his slouched posture. Respiratory infections and in this case, pneumonia, will further impair the airway (Lemon, & Burke, 2011). Because of the combination of pneumonia and R.M's other diagnoses of lifelong asthma, it is imperative that the nursing care plan of ineffective airway clearance be carried out. The first goal of this care plan was to have the patient breathe deeply and cough to remove secretions. It is important that the nurse help the patient deep breathe in an upright position; this is the best position for chest expansion, which promotes expansion and ventilation of all lung fields (Sparks and Taylor, 2011). It is also important the nurse teach the patient an easily performed cough technique and help mobilize the patient with ADL's. This helps the patient learn to cough and clear their airways without fatigue (Sparks a...