Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.

Mechanically Ventilating the Severe Asthmatic

The management of the critically ill patients with asthma can be rather challenging. Potentially devastating complications relating to this presentation include hypoxemia, worsening bronchospasm, pulmonary aspiration, tension pneumothorax, dynamic hyperinflation, hypotension, dysrhythmias, and seizures. In contrast to various other pathologies requiring mechanical ventilation, acute asthma is generally associated with better outcomes. This review serves as a practical guide to the physician managing patients with severe acute asthma requiring mechanical ventilation. In addition to specifics relating to endotracheal intubation, we also discuss the interpretation of ventilator graphics, the recommended mode of ventilation, dynamic hyperinflation, permissive hypercapnia, as well as the role of extracorporeal membrane oxygenation and noninvasive mechanical ventilation.

Extracorporeal carbon dioxide removal (ECCO2R) in respiratory deficiency and current investigations on its improvement: a review

The implementation of extracorporeal carbon dioxide removal (ECCO₂R) as one of the extracorporeal life support system is getting more attention today. Thus, the objectives of this paper are to study the clinical practice of commercial ECCO₂R system, current trend of its development and also the perspective on future improvement that can be done to the existing ECCO₂R system. The strength of this article lies in its review scope, which focuses on the commercial ECCO₂R therapy in the market based on membrane lung and current investigation to improve the efficiency of the ECCO₂R system, in terms of surface modification by carbonic anhydrase (CA) immobilization technique and respiratory electrodialysis (R-ED). Our methodology approach involves the identification of relevant published literature from PubMed and Web of Sciences search engine using the terms Extracorporeal Carbon Dioxide Removal (ECCO₂R), Extracorporeal life support, by combining terms between ECCO₂R and CA and also ECCO₂R with R-ED. This identification only limits articles in English language. Overall, several commercial ECCO₂R systems are known and proven safe to be used in patients in terms of efficiency, safety and risk of complication. In addition, CA-modified hollow fiber for membrane lung and R-ED are proven to have good potential to be applied in conventional ECCO₂R design. The detailed technique and current progress on CA immobilization and R-ED development were also reviewed in this article.