A patient with severe asthma being treated in the intensive care unit (ICU) needs to be monitored for a number of complications. Proper management can keep these complications to a minimum.


Barotrauma associated with mechanical ventilation:

(1) pulmonary interstitial emphysema

(2) pneumothorax

(3) pneumomediastinum or pneumopericardium

(4) pneumoperitoneum

(5) subcutaneous emphysema


Other complications of mechanical ventilation:

(1) myopathy if depolarizing agents are used

(2) tracheoesophageal fistula

(3) ventilator-associated pneumonia


Cardiovascular complications:

(1) hypotension

(2) cardiac arrhythmias

(3) myocardial ischemia or infarction


Metabolic complications:

(1) lactic acidosis

(2) hyperglycemia

(3) hypokalemia

(4) hypophosphatemia

(5) hypomagnesemia

(6) hypercapnia/hypercarbia


Drug toxicities:

(1) theophylline toxicity

(2) beta-agonist toxicity


Other complications:

(1) post-traumatic stress disorder (PTSD)

(2) hypoxic encephalopathy

(3) atelectasis with or without mucous plugging


Ways to reduce these complications:

(1) Aggressive management to minimize the time in the ICU.

(2) Permissive hypercapnia.

(3) Noninvasive ventilation

(4) Avoidance of muscle relaxants

(5) Supportive ventilatory settings (prolonged expiratory time, patient-ventilator synchrony)


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