High frequency percussive ventilation as a rescue mode for refractory status asthmaticus – a case study

Abstract

Introduction

A severe asthma exacerbation is called status asthmaticus when symptoms worsen despite conventional medical treatment in the hospital. If arterial blood gas (ABG) values deteriorate and this is accompanied by respiratory muscle fatigue, the patient will require mechanical ventilation. However, mechanical ventilation of the severe asthmatic presents difficult challenges.

Case Study

We report on High Frequency Percussive Ventilation (HFPV) used along with continuous inhaled albuterol and neuromuscular blockade, as rescue therapy for a case of acute, severe asthma that was refractory to conventional treatment and conventional mechanical ventilation.

Results

This patient’s arterial pH was 6.97 when we initiated HFPV, but ten hours post-intubation her ABG values normalized. She was successfully extubated six days later and discharged from ICU the following day.

Conclusion

This case describes the successful use of HFPV for a status asthmaticus patient failing conventional mechanical ventilation. We have anecdotal evidence of other medical centers using HFPV for these patients but larger studies are needed to verify its efficacy.

Keywords:

• Acute severe asthma
• status asthmaticus
• HFPV
• VDR®-4
• high frequency percussive ventilation

Declaration of interest

The authors declare that there is no conflict of interest regarding the publication of this case study. Further, the authors have no financial interest in any ventilator, corporation, medication, or therapy, mentioned in this case study.