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Emergency Department Airway Management for Status Asthmaticus With Respiratory Failure
Haley T Godwin1, Megan L Fix2, Olesya Baker3
1School of Medicine, University of Utah, Salt Lake City, Utah. Haley.godwin@hsc.utah.edu.
Respiratory Care
|July 30, 2020
Summary
Emergency department intubations for status asthmaticus are uncommon, representing about 1% of medical intubations. Rapid-sequence intubation with bi-level positive airway pressure and ketamine is the preferred method, showing high success rates.
Area of Science:
- Emergency Medicine
- Pulmonology
- Critical Care
Background:
- Limited data exists on emergency department (ED) airway management for status asthmaticus.
- This study details current practices and outcomes for intubating patients with status asthmaticus in the ED.
Purpose of the Study:
- To describe the foremost methods and outcomes of airway management in ED patients requiring intubation for status asthmaticus.
- To analyze the incidence, techniques, and adverse events associated with asthma-related intubations.
Main Methods:
- Analysis of intubations for asthma from January 2016 to December 2018 using the National Emergency Airway Registry (NEAR).
- Prospective, observational registry of 25-center ED intubations.
- Descriptive statistics and cluster-adjusted incidence with 95% CI were used to report findings.
Main Results:
- Asthma accounted for 1.2% of all medical intubations (173/14,517).
- First-attempt intubation success was 90.8%, with 100% overall success.
- Patients with asthma were more likely to receive rapid-sequence intubation (96.5%), bi-level positive airway pressure (BPAP) preoxygenation (62.9%), and ketamine induction (51.8%) compared to other medical indications.
Conclusions:
- Status asthmaticus represents approximately 1% of emergent medical intubations.
- Rapid-sequence intubation with BPAP preoxygenation and ketamine induction are common practices for status asthmaticus.
- These methods demonstrate high success rates and comparable adverse event rates to other medical intubations.
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