Near-fatal asthma syndrome. Regarding a case.

Abstract

Introduction: Severe asthma exacerbations, including near-fatal asthma, have high morbidity and mortality upon admission to the ICU: 2-5%. In mechanical ventilation: 1.3%. Mortality: 2.5%. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Risk factors are a previous episode of near-fatal asthma, excess of bronchodilators, or lack or interruption of systemic or inhaled corticosteroids.

Clinical case: A 25-year-old man with a history of asthma was admitted to the emergency department with 1 hour of stupor, diaphoresis, respiratory failure, and cyanosis. The situation began suddenly after the exposure to biofuels. To physical examination with Glasgow 8/15. The presence of wheezing in both lung fields was hypoventilated. He was intubated and maintained on invasive mechanical ventilation for 12 days, sedated, relaxed for 72 hours, received short-acting beta-2 agonist bronchodilators and short-acting anticholinergic bronchodilators, inhaled corticosteroids; ventilatory parameters were managed in such a way that he managed to reach to hypoxemia and permissive hypercapnia, in addition to receiving antifimic treatment due to the discovery of M. tuberculosis in bronchoalveolar lavage.

Conclusion: Treatment consists of administering bronchodilators, corticosteroids, life support, oxygen therapy, and mechanical ventilation. To reverse air trapping, the strategy involves prolonging expiratory time and decreasing respiratory rate and inspiratory time at high flows. Measuring the intrinsic positive end-expiratory pressure predicts mortality and allows for evaluating the effectiveness of the ventilatory strategy devised.