What is the role of controlled hypoventilation in the treatment of status asthmaticus?

Updated: Jun 17, 2020
  • Author: Constantine K Saadeh, MD; Chief Editor: John J Oppenheimer, MD  more...
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In the face of high peak airway pressures, the principle of mechanical ventilation in status asthmaticus is controlled hypoventilation with toleration of higher levels of PCO2 in order to minimize tidal volume and peak inspiratory pressures. Permissive hypercapnia can be tolerated as long as the patient remains adequately oxygenated. A longer inspiration/expiration (I/E) ratio, often greater than 1:3-4, helps to allow time for optimal exhalation, facilitating ventilation and avoiding an excessive amount of further air trapping (auto–positive end-expiratory pressure [auto-PEEP]).

Keep in mind, however, that patients may be uncomfortable and air hungry while ventilated with low respiratory rates, prolonged exhalation times, and hypercapnia due to a strategy of controlled hypoventilation.

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