Correct!
5. All of the above

Ketamine IV anesthesia has also been tried for severe asthma with some success (6). Heliox, a mixture of helium and oxygen, is less dense than air which is predominately nitrogen and oxygen. Because it is less dense, heliox lowers upper airway resistance and has also been successfully used in severe asthma (7). Similarly, successes have also been reported with ECMO (8-10).

In our patient, a trial of ECMO resulted in improvement in her arterial blood gases to pH 7.475, pCO2 of 33 mm Hg, and pO2 of 508 mm Hg on a FiO2 of 100% within 4 hours of initiation. She slowly improved, was extubated and eventually discharged to home.

No rescue therapy has been proven to be superior to another and there are no controlled trials comparing therapies. Early ECMO may be life-saving although when to initiate ECMO has not been standardized yet.

References

  1. Fanta CH. Treatment of acute exacerbations of asthma in adults. UpToDate. June, 2010. Available at: http://nihlibrary.ors.nih.gov/jw/POC/Uaea.htm (accessed 1/25/15).  
  2. Shapiro JM. Management of respiratory failure in status asthmaticus. Am J Respir Med. 2002;1(6):409-16. [CrossRef] [PubMed]
  3. Centers for Disease Control. Influenza antiviral medications: summary for clinicians. Available at: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm (accessed 1/25/15).
  4. Saulnier FF, Durocher AV, Deturck RA, Lefèbvre MC, Wattel FE. Respiratory and hemodynamic effects of halothane in status asthmaticus. Intensive Care Med. 1990;16(2):104-7. [CrossRef] [PubMed]
  5. Johnston RG, Noseworthy TW, Friesen EG, Yule HA, Shustack A. Isoflurane therapy for status asthmaticus in children and adults. Chest. 1990;97(3):698-701. [CrossRef] [PubMed]
  6. Hemming A, MacKenzie I, Finfer S. Response to ketamine in status asthmaticus resistant to maximal medical treatment. Thorax. 1994;49(1):90-1. [CrossRef] [PubMed]
  7. Gluck EH, Onorato DJ, Castriotta R. Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis. Chest. 1990;98(3):693-8. [CrossRef] [PubMed]
  8. Shapiro MB, Kleaveland AC, Bartlett RH. Extracorporeal life support for status asthmaticus. Chest. 1993;103(6):1651-4. [CrossRef] [PubMed]
  9. Kukita I, Okamoto K, Sato T, Shibata Y, Taki K, Kurose M, Terasaki H, Kohrogi H, Ando M. Emergency extracorporeal life support for patients with near-fatal status asthmaticus. Am J Emerg Med. 1997;15(6):566-9. [CrossRef] [PubMed]
  10. Mikkelsen ME, Woo YJ, Sager JS, Fuchs BD, Christie JD. Outcomes using extracorporeal life support for adult respiratory failure due to status asthmaticus. ASAIO J. 2009;55(1):47-52. [CrossRef] [PubMed]

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