Emergency casebook
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Noninvasive ventilation (NIV) is the provision of ventilatory support without the need for an invasive airway, and has revolutionised the management of patients with diverse forms of respiratory failure. The advantages of NIV include improved patient comfort, reduced need for sedation, whilst avoiding the complications of endotracheal intubation, including upper airway trauma, sinusitis, otitis, and nosocomial pneumonia. In selected patients NIV has also been shown to improve survival. The role of NIV in acute severe asthma is at best controversial. In this case report we describe a patient with acute severe asthma who was initially managed with NIV, and who failed a trial of NIV, and was successfully managed with invasive ventilation. We also review the pathophysiological mechanisms of benefit of NIV in acute severe asthma, and the current literature on the use of NIV in acute asthma.
In conclusion, a trial of NIV in acute asthma may be justified
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Emerg. Med. J. 2006 23: 87.[Extract] [Full Text] [PDF]
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