Ventilation in Status Asthmaticus
Acute severe asthma, also known as status asthmaticus, is a severe condition wherein the respiratory airway becomes inflammed, which leads to airway obstruction, causing a person’s oxygen deprivation and potential death (Stather & Stewart 2005:para.1 ). There are different triggering factors to the acute episodes of severe asthma commonly caused by allergic reaction to exposure to dusts, mites, and other allergens. The severity of the condition prompts immediate clinical intervention to relieve airway obstruction. This essay will discuss the method of ventilating a patient with acute severe asthma. In addition, the role of lateral chest thrusts in the management of acute severe asthma will also be discussed.
In patients with status asthmaticus, the main goal of intervention is to provide adequate oxygenation and prevent air trapping while doing this. Hence, ventilation of the patient is the key intervention to relieve oxygen deprivation. Mechanical ventilation can be done through noninvasive and invasive procedures. However, it is important to note that complications may arise from this intervention, for example, air trapping, hence, actions should be geared toward providing optimum oxygenation for the client through mechanical ventilation while preventing complications that can lead to death (Stather & Stewart 2005:para. 2).
Noninvasive positive pressure ventilation (NPPV), from the word itself, is a noninvasive procedure used to provide oxygenation to the patient during episodes of acute severe asthma. NPPV is commonly delivered via oxygen face mask, nasal cannula, and other oxygen devices. Oxygen can be delivered through these devices by volume, pressure, and timed oxygen delivery settings (Soo Hoo 2010). Similar to any intervention, nursing considerations are observed in carrying out NPPV. Most importantly, appropriate selection of patients to whom this type of intervention will be carried out should be identified. This type of intervention should never be administered to patients who are in coma, cardiac and respiratory arrest, and other life-threatening conditions that require intubation rather than NPPV (Soo Hoo 2010).
The second method of ventilating the patient with status asthmaticus is through invasive mechanical ventilation or intubation. The physician decides to intubate the patient based on deteriorating symptoms present in the patient such as increasing levels of carbon dioxide, decreasing mental status based on Glasgow Coma Scale, unstable hemodynamic status, and refractory hypoxemia (Stather & Stewart 2005:para.5). Mechanical intubation is done by inserting an endotracheal tube, which will be connected to a mechanical ventilator machine, in the client’s airway. Similar to NPPV, oxygen delivery settings are controlled in the machine.
The ventilation methods discussed in the previous paragraphs are done in the hospital setting. However, there is an evolving management technique for status asthmaticus commonly used in emergency and non-hospital settings. This management technique is called the lateral chest compressions. No evidence or empirical data can adequately support this intervention yet, but its popularity of use among ambulance services makes this a controversial but effective intervention (Williams et al. 2007).
Lateral chest compressions or external chest compressions (ECC) are performed by a professional health care provider. There are two positions in which ECC can be done based on the patient’s position, either anterior or posterior approach. ECC is done by placing the hands in a lateral position on either side of the patient’s thoracic cage. After placement of the hands, the health provider then applies pressure gently but firmly on the thoracic cage when the client exhales (Williams et al. 2007). The health care provider may opt to do the anterior approach when the client is unconscious and left on a supine position and posterior approach can be used when the client is conscious and can position his back toward the health provider.
External chest compressions have a critical role in providing basic emergency intervention in patients experiencing status asthmaticus because this intervention does not require equipment or other instruments for implementation. This manual intervention can be simply performed independently by the health provider, hence, the patient is able to receive immediate intervention. Immediate oxygen delivery and prevention of gas trapping caused by airway obstruction are crucial in the management of status asthmaticus because the time necessary to deliver the intervention determines the reversibility of the condition or potential death of the patient (Williams et al. 2007).
Summary
Status asthmaticus or acute severe asthma is a life-threatening condition caused by airway obstruction from inflammation of the respiratory airway. The main goal of interventions for status asthmaticus is to administer adequate oxygenation and prevent gas trapping. If these interventions are not carried out immediately, oxygen deprivation will be irreversible and death will occur.
There are two major methods of ventilating the patient with status asthmaticus, specifically, non-invasive and invasive mechanical ventilation. Non-invasive positive pressure ventilation delivers oxygen through the face mask, nasal cannula, and other noninvasive oxygen devices. On the other hand, invasive mechanical ventilation or mechanical intubation delivers oxygen via endotracheal tube or other invasive oxygen devices connected to a mechanical ventilator. Oxygen delivery through these oxygen devices can be set according to volume, pressure, or time.
An evolving management technique, lateral chest compressions, for status asthmaticus is being practiced by health care providers. This manual technique is seen as very effective and usable in the out-of-hospital area because of the ease of delivery of this technique. This intervention has been used in both hospital and out-of-hospital areas but its growing use and effectivity is discovered outside the hospital setting because this intervention can be used even without equipment or instruments that are only available from the hospital. Moreover, the technique is easy to do, as well as time-efficient, in providing emergency interventions for patients experiencing acute severe asthma. Hence, this technique is a promising new intervention that should be researched and investigated to provide empirical evidence for its use (Williams et al. 2007).
List of References
Soo Hoo, G. W. (2010) ‘Ventilation, noninvasive’ [online]. Available from <http://emedicine.medscape.com/article/304235-overview> [02 June 2010]
Stather, D. R. & Stewart, T. E. (2005) ‘Clinical review: Mechanical ventilation in severe asthma’ Critical Care [online] 9: 581-587. Available from <http://ccforum.com/content/9/6/581> [01 June 2010]
Williams, B., Fallows, B. and Allan, J. (2007) ‘Investigating the benefits of out-of-hospital external chest compression’ Journal of Emergency Primary Health Care [online] 5, (3): 1-9. Available from <www.jephc.com/uploads/990219BW1.pdf> [02 June 2010]