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Managing the deteriorating ventilated asthmatic

  1. Immediately take off ventilator and allow patient to expire (can use both hands to press on chest to mechanically assist expiration)

  2. Attach bag and 15L/min oxygen and gently ventilate assessing lung compliance

  3. Assess ‘MASH’

  • Movement of the chest during ventilation

  • Arterial saturation (SaO2) and PaO2

  • Skin colour of the patient (are they turning blue or pinking up?)

  • Hemodynamic stability

  1. Look for the cause of deterioration - ‘DOPES’

  • Displacement of the ETT

  • Obstruction of the ETT

  • Patient factors— inadequately sedated/paralysed, pneumothorax, lobar collapse, bronchospasm

  • Equipment — ventilator problems

  • ‘Stacked breaths’ — AKA dynamic hyperinflation/auto PEEP

  1. Address the causes for deterioration

  2. If you run into trouble ventilating the asthmatic on the oxylog, borrow the more sophisticated ICU transport ventilator whilst awaiting a bed. The priority is to get this patient to an ICU and transition to a formal ventilator.

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