The Application Of Mechanical Ventilation In The Treatment Of Severe Asthma

Background Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play an important role, associated with mucus hypersecretion, variable airflow obstruction and airway hyperresponsiveness(AHR). Along asthma is easy to be controlled by inhaled glucocorticoids, the exacebation of the asthma and the severe asthma are usually under control , which termed "fatal asthma", then the symptoms usually can't be alleviated by usual treatment such as medicine,at this time, mechanical ventilation(MV) is the only way to save life. In 1961, Leonhardt first reported the treatment of severe asthma by MV, and found the complications of MV were not low ,the mortality rate of which was nearly 22%. As well known, the sudden death of severe asthma was usually caused by severe respiratory failure and anoxia. We should positively proceed artificial mechanical ventilation when medicine treatment are invalid, otherwise the mortality is very high. Also some scholars showed that the purpose of MV was to win time for themedicine treatment and make respiratory muscle to have a break. Zimmerman JL reported that the occurance rate of complications by MV was 45%. Although we recognize the importance of MV in the treatment of severe asthma, we still do not know which time is optimal to apply MV. So, the purpose of the study is to discuss the optimal opportunity of application of MV in the severe asthma . Methods (1).Review the clinical data of 25 Patients with severe asthma who demanded ventilation in ICU of hospital. Among them,8 cases were male,and 17 were female, age 26 - 75 years old, average age 44.24 13.39 years old. The patients were divided into two groups according to the mechanical ventilation circumstance. I group was to delay using mechanical ventilation , 16 cases, among them 5 cases, are male,ll were female, II group applied machine ventilation on time, 9 cases, among them 3 are male, 6 are female .There was no statistic difference in age, (44.69 15.03,43.67 10.83, P>0.05), APACHE II score (8.19 2.43,7.89 2.09 P>0.05). (2).A11 patients used corticosteroid , aminophylline ,inhaled beta-agonists, normally used the oxygen, liquid,correct acidosis or used the tranquilizer and muscle relaxation when pation resisted ,used the antibiotics treatment when patients suffered infection.(3)..Record index: age, sex, Serious degree, Physiology index and, opportune moment of mechanical ventilation, result of treatment. Result1. The I group survived 7 cases, survive rate 43.75%, the II group survived 9 cases, survive rate 100%.( P<0.05) . complications appeared in 8 cases in I group,among them pneumothorax 1 cases, pneumonia 4 cases, bleed in digestive tract 1case, renal failure 1 case, multiple organ dysfunction syndrome 1 case. Nocomplication appeared in II group.2. Compared with II group , I group required ventilation for long periods(I group5.83 3.04 days VS II group 2.89 1.69 days P<0.05), I group required hospital lengthof stay for long periods(I group 12.00 7.65days VS II group5-33 1.87 daysP<0.05).ConclusionThe mechanical ventilation have may kind of complications, it also is a kind of important treatment for severe asthma,can win time for other medicine treatment .to severe asthma , To treat severe asthma with mechanical ventilation in earlier period , it can effectively reduce the patients' mortality and the occurrence rate of the complications, shorten the mechanical ventilation period as well as the hospital length of stay .