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Life-threatening asthma — SCE Respiratory MCQ

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HardAsthmaLife-threatening asthmaSCE Respiratory

A 21-year-old student is admitted with severe asthma after 24 hours of worsening wheeze. He is exhausted after nebulised bronchodilators, magnesium and intravenous hydrocortisone. Respiratory rate is 10/min, SpO2 92% on high-flow oxygen, pH 7.19, PaCO2 8.1 kPa and PaO2 10.4 kPa. What is the most appropriate ventilation strategy?

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Correct answer: D — Urgent intubation and invasive ventilation

A rising PaCO2 with exhaustion and acidaemia in acute asthma indicates impending respiratory arrest and requires urgent critical care intubation by an experienced team. NIV is not a substitute for invasive ventilation in a crashing asthmatic with reduced respiratory effort. Oxygen should not be deliberately reduced to COPD targets in acute severe asthma.

Reference: BTS Asthma Attack Care Bundle; BTS/SIGN Acute Asthma Guidance