Khadadah M E, Onadeko B O, Mustafa H T, Metwali K E
Department of Medicine, Faculty of Medicine, Kuwait University.
Singapore Med J. 2000 May;41(5):214-7.
The recognition and management of severe acute asthma have attracted considerable attention since the seventies because of the morbidity and mortality that may accompany the condition. Recognition and appropriate management of severe acute asthma is essential. Admission to intensive care, intubation and ventilation risks versus benefit have been argued. We highlight these controversies by documenting our experience and comparing it to others in the literature
We prospectively document our experience over a two-year period in the management of severe asthma in the intensive Care Unit (ICU). Patients were established asthmatics, who came in severe exacerbation. Attention was paid to the duration of onset of acute attack, time to presentation, spirometric and blood gas data, the type of treatment given, factors responsible for complications and mortality were identified. The findings in this study were compared with those in similar studies in the literature.
A total of 30 patients were studied. Twenty-one patients were ventilated and 9 were not. 82% had a history of asthma longer than 5 years. The duration of symptoms before admission to ICU was very short (one day or less in 57%). Hypercapnia was significantly higher in intubated patients. The duration of stay in ICU and hospital was longer for intubated patients (P<0.02). Complications were higher in intubated patients.
ICU care provides an excellent setting for management of acute severe asthma. The reported high morbidity and mortality in ICU can be improved. Without ICU care the mortality and morbidity increases,so physicians should not hesitate to admit asthmatics early to ICU.
自七十年代以来，由于严重急性哮喘可能伴随的发病率和死亡率，其识别与管理一直备受关注。识别并妥善管理严重急性哮喘至关重要。对于重症监护病房收治、插管和通气的风险与益处一直存在争议。我们通过记录自身经验并与文献中的其他经验进行比较，突出这些争议点。
我们前瞻性地记录了在重症监护病房（ICU）对严重哮喘进行为期两年的管理经验。患者均为确诊的哮喘患者，且病情严重恶化。关注急性发作的持续时间、就诊时间、肺功能和血气数据、所给予的治疗类型，确定导致并发症和死亡的因素。将本研究的结果与文献中类似研究的结果进行比较。
共研究了30例患者。21例患者接受了通气治疗，9例未接受。82%的患者哮喘病史超过5年。入住ICU前症状持续时间非常短（57%的患者为一天或更短）。插管患者的高碳酸血症明显更高。插管患者在ICU和医院的住院时间更长（P<0.02）。插管患者的并发症更多。
ICU护理为急性重症哮喘的管理提供了良好的环境。ICU中报道的高发病率和死亡率是可以改善的。没有ICU护理，死亡率和发病率会增加，因此医生应毫不犹豫地尽早将哮喘患者收入ICU。
