Mechanical Ventilation in Status Asthmaticus Part 1 with Dr. Mekela Whyte-Nesfield

02/06/23 • 31 min

Dr. Whyte-Nesfield is a Critical Care attending at Children’s National Hospital in Washington, DC. She completed her medical degree in her home country of Grenada at St. George’s University, and her fellowship in Pediatric Critical Care at Penn State Health Children’s Hospital, PA. Mekela’s research interest is the role of parent and child traumatic stress management in improving long term outcomes of children in the PICU; she ran a multi-center prevalence study during her fellowship. She is also interested in advanced ventilator modes and educating the next generation of intensivists about pulmonary physiology.
Objectives:
After listening to this episode, listeners should be able to:

Define indications for intubation in a patient with asthma.
Review adjunct therapies, including high-dose steroids, mag, epi, terbutaline, isoproterenol, aminophylline, isoflurane, and manual decompression of the chest.
Identify the physiologic and logistic rationale supporting each mode of mechanical ventilation in asthma (PRVC vs PCPS).
Identify the benefits and risks of paralyzing an intubated asthmatic.
Discuss the relationshiop between static compliance, dynamic compliance, and reversible bronchoconstriction.
Describe the complications of mechanical ventilation in asthma, including indications for ECMO.

References:

Manual external chest compression reverses respiratory failure in children with severe air trapping. Pediatric Pulmonology, 56(12), 3887–3890. https://doi.org/10.1002/ppul.25689
Mechanical ventilation of the intubated asthmatic: How much do we really know? *. Pediatric Critical Care Medicine, 5(2), 191–192. https://doi.org/10.1097/01.CCM.0000113929.14813.51
Volatile Anesthetic Rescue Therapy in Children With Acute Asthma. Pediatric Critical Care Medicine, 14(4), 343–350. https://doi.org/10.1097/PCC.0b013e3182772e29
Pressure-controlled ventilation in children with severe status asthmaticus*. Pediatric Critical Care Medicine, 5(2), 133–138. https://doi.org/10.1097/01.PCC.0000112374.68746.E8
Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment*. Pediatric

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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at [email protected]. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Define indications for intubation in a patient with asthma.
Review adjunct therapies, including high-dose steroids, mag, epi, terbutaline, isoproterenol, aminophylline, isoflurane, and manual decompression of the chest.
Identify the physiologic and logistic rationale supporting each mode of mechanical ventilation in asthma (PRVC vs PCPS).
Identify the benefits and risks of paralyzing an intubated asthmatic.
Discuss the relationshiop between static compliance, dynamic compliance, and reversible bronchoconstriction.
Describe the complications of mechanical ventilation in asthma, including indications for ECMO.

References:

Manual external chest compression reverses respiratory failure in children with severe air trapping. Pediatric Pulmonology, 56(12), 3887–3890. https://doi.org/10.1002/ppul.25689
Mechanical ventilation of the intubated asthmatic: How much do we really know? *. Pediatric Critical Care Medicine, 5(2), 191–192. https://doi.org/10.1097/01.CCM.0000113929.14813.51
Volatile Anesthetic Rescue Therapy in Children With Acute Asthma. Pediatric Critical Care Medicine, 14(4), 343–350. https://doi.org/10.1097/PCC.0b013e3182772e29
Pressure-controlled ventilation in children with severe status asthmaticus*. Pediatric Critical Care Medicine, 5(2), 133–138. https://doi.org/10.1097/01.PCC.0000112374.68746.E8
Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment*. Pediatric

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

Previous Episode

PARDS--Beyond the Basics Part 4 with Dr. Nadir Yehya: Adjunctive Strategies (prone positioning, steroids, paralysis, iNO etc)

Dr. Yehya is a graduate of the University of California at Berkeley and the University of California at Los Angeles School of Medicine. After completing pediatrics training at Children’s Hospital of Los Angeles, he completed his pediatric critical care fellowship at Children’s Hospital of Philadelphia (CHOP), and joined the faculty after graduation in 2011. He is currently an Assistant Professor of Anesthesiology and Critical Care and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending physician in the pediatric intensive care unit at CHOP.

Dr. Yehya’s research interests encompass all aspects of pediatric respiratory failure, with a particular emphasis on pediatric acute respiratory syndrome (ARDS) and mechanical ventilation. ARDS consists of sudden, severe flooding of the lungs in response to an inflammatory insult causing difficulty breathing, frequently requiring mechanical ventilation. Sepsis is a leading cause of ARDS in children. His long-term goal is better characterization of ARDS in children and to test therapies designed to improve outcomes. His NIH-funded work is assessing the utility of specific plasma biomarkers in pediatric ARDS, with subsequent proteomic characterization and testing in pre-clinical models. Dr. Yehya has several active studies involving biomarkers, clinical epidemiology, and pathophysiological mechanisms in the field of pediatric ARDS, and is involved in several multicenter and multinational collaborations.
Objectives:

After listening to this episode, learners should be able to:

Understand the role of heated high-flow nasal cannula and non-invasive mechanical ventilation in the management of pediatric acute respiratory distress syndrome (PARDS).
Recognize the potential for patient self-inflicted lung injury in PARDS.
Recognize high-risk situations when non-invasive mechanical ventilation is relatively contraindicated in favor of intubation and mechanical ventilation.

Acknowledgement:
Thank you to Dr. Nick Bartel for his help in creating learning objectives for this series.
Selected references:
PMID: 10793162
PMID: 25693014
PMID: 15269312
PMID: 30361119
PMID: 17426195
PMID: 31112383
PMID: 25647235
PMID: 19001507
PMID: 32043986
PMID: 15671432

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show

Next Episode

Mechanical Ventilation in Status Asthmaticus Part 2 with Dr. Mekela Whyte-Nesfield

Define indications for intubation in a patient with asthma.
Review adjunct therapies, including high-dose steroids, mag, epi, terbutaline, isoproterenol, aminophylline, isoflurane, and manual decompression of the chest.
Identify the physiologic and logistic rationale supporting each mode of mechanical ventilation in asthma (PRVC vs PCPS).
Identify the benefits and risks of paralyzing an intubated asthmatic.
Discuss the relationshiop between static compliance, dynamic compliance, and reversible bronchoconstriction.
Describe the complications of mechanical ventilation in asthma, including indications for ECMO.

References:

Manual external chest compression reverses respiratory failure in children with severe air trapping. Pediatric Pulmonology, 56(12), 3887–3890. https://doi.org/10.1002/ppul.25689
Mechanical ventilation of the intubated asthmatic: How much do we really know? *. Pediatric Critical Care Medicine, 5(2), 191–192. https://doi.org/10.1097/01.CCM.0000113929.14813.51
Volatile Anesthetic Rescue Therapy in Children With Acute Asthma. Pediatric Critical Care Medicine, 14(4), 343–350. https://doi.org/10.1097/PCC.0b013e3182772e29
Pressure-controlled ventilation in children with severe status asthmaticus*. Pediatric Critical Care Medicine, 5(2), 133–138. https://doi.org/10.1097/01.PCC.0000112374.68746.E8
Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment*. Pediatric C

Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & Zac

Support the show