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
(3) pneumomediastinum or pneumopericardium
(5) subcutaneous emphysema
Other complications of mechanical ventilation:
(1) myopathy if depolarizing agents are used
(2) tracheoesophageal fistula
(3) ventilator-associated pneumonia
(2) cardiac arrhythmias
(3) myocardial ischemia or infarction
(1) lactic acidosis
(1) theophylline toxicity
(2) beta-agonist toxicity
(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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