Written by Clay Smith
Non-invasive ventilation (NIV) may reduce the need for subsequent invasive mechanical ventilation (IMV) and reduce mortality among critically ill asthmatic patients.
Why does this matter?
We would rather not intubate asthmatic patients. They are at increased risk for PEA, pneumothorax, and ventilator associated pneumonia. NIV works well to reduce IMV in COPD patients, but its effect on asthma is not as well defined. Use of NIV for asthma has been embraced, and use is increasing. But does it benefit patients?
Mask or tube?
This was a retrospective review of ICU admissions from 682 hospitals that included 53,654 patients with asthma exacerbations. Of these, 13,540 (25%) had NIV; 14,498 (27%) had IMV total; 1,291 (2.4%) died in hospital. They used generalized estimating equations (GEE) as a mathematical way to account for variables that could have impacted the outcomes, such as, “patient characteristics, comorbidities, early treatments and testing, and hospital characteristics.” Patients who received NIV had a 64% lower odds of needing IMV (aOR 0.36, 95%CI 0.32-0.40) and the odds of death were reduced by 52% (aOR 0.48, 95%CI 0.40-0.58). It is likely that NIV was used in lower severity patients who would never require IMV, which may have confounded results. However, the equations tried to account for this. Propensity matching also found similar results. While these statistical methods are not equal to a RCT, this study confirms my clinical approach. When I have an asthmatic patient whom I think has a good chance of progressing to need intubation, but they still have good mental status, I will start NIV. It appears this practice may reduce the number of people who will need IMV and who will die of the illness.
Noninvasive Ventilation Use in Critically Ill Patients with Acute Asthma Exacerbations. Am J Respir Crit Care Med. 2020 Dec 1;202(11):1520-1530. doi: 10.1164/rccm.201910-2021OC.
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