Authors: Jones, Jeff; Murin, Susan

Source: Clinical Reviews in Allergy and Immunology, Volume 20, Number 3, June 2001 , pp. 399-413(15)

Publisher: Humana Press

Abstract:

Nearly seven decades have passed since Barach described the first cases of asthma managed with heliox, and Fuchs reported the therapeutic use of general anesthesia for severe asthmatics. Since then, IV anesthetics, BAL and ECLS have been added to the list of salvage therapies for patients with refractory asthma. Furtunately, most patients will respond to conventional therapies, but for those who don't, we lack good evidence to guide us in our choice of further treatments. Heliox has been demonstrated in some but not all studies to improve airflow and other parameters among patients with asthma, without any significant side effects. It is reasonable to give a therapeutic trial of heliox in patients with severe airflow obstruction who are felt to be at risk of respiratory muscle fatigue and respiratory failure. For intubated patients on mechanical ventilatory, support, heliox may be given through the ventilator circuit, but the potential issues with inaccuracy of flow meters for this low-density gas must be considered. Limited evidence supports the use of propofol in refractory SA; given its ready availability and ease of administration, it is worth trying in the hemodynamically stable asthmatic patients. Extreme caution should be exercised in administering this drug to a nonintubated patient. Inhalational anesthesia should be left for cases in which propofol has failed or cannot be tolerated, given the difficulties in its therapeutic administration. Therapeutic BAL may be of benefit in selected patients with mucous plugging, but criteria for selecting patients for this aggressive and potentially dangerous intervention are not clear. ECLS may be considered as a last ditch effort for the patient with SA who has inadequate gas exchange despite all other available therapies.

Document Type: Research article

DOI: http://dx.doi.org/10.1385/CRIAI:20:3:399

Affiliations: 1: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of California, Davis, 4150 V Street, Suite 3400, 95817, Sacramento, CA,

Publication date: 2001-06-01

Related content

• In this: publication
• By this: publisher
• In this Subject: Allergy & Immunology
• By this author: Jones, Jeff ;  Murin, Susan

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers