Does non-invasive ventilation improve patient outcome or relive symptoms in acute asthma attacks
- Report By: David Jeffrey - Resuscitation officer
- Search checked by David Jeffrey - Resuscitation officer
- Institution: GG&C
- Date Submitted: 4th April 2016
- Last Modified: 25th May 2016
-
Status:
Blue (submitted but not checked)
Three Part Question
in [patients with acute asthma] does [Non invasive ventilation] improve [outcome, ITU admission, need for invasive ventilation]Clinical Scenario
in patients wirh acute severe asthma, does NIV improve outcome?Search Strategy
Cinahl, medline, embase database searchesKey words used asthma, NIV, Non-invasive ventilation. searches comined using and/ or selection limited to English, Adult, human.
Search Outcome
74 articles in initial results.duplicates removed. Titles read and then abstracts from relevent titles.
4 RCTs identified for review.
Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Gupta et al 2010 India | Adults with acute severe asthma | Rct patients with acute severe asthma attending a&e after diagnosis were randomised into control where standard medical treatment was given and intervention, standard medical treatment + NIV | NIV arm had shorter LOS IN ICU, | Mean dose of inhaled bronchodilator was less | Small RCT. 53 included in trial |
| Soma et al 2008 Japan | Patients with acute asthma with mild or moderate severity | RCT standard medical therapy( control)14 high pressure NIV intervention group 14and low pressure intervention group. 12 | Nippv(h)FEV1 significantly improved in intervention group | Nippv(h) significant improvement in modified Borg scale acore | Small study 12-14 in each group |
| Soroksky et al 2003 Finland | Adults with acute severe asthma | RCT. Blinded. Conventional medical treatment in + sham ventilation. (Control) standard conventional medical treatment + NIV in intervention | FEV pefr FCV significantly better than control arm | Respiratory rate less in I tervention | Small trial. No mention of how randomisation was carried out. |
Comment(s)
No statistically significant differences found between groups in PEF or spirometry however the intervention group had a shorter ICU stay and reduced LOS in hospital.Clinical Bottom Line
NIV could reduce LOS IN ICU and hospital in patients with acute severe asthmaReferences
- Brandao et al Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma Journal of asthma 2009 pp 356-361
- Gupta et al A prospective randomised control trial on the efficacy of noninvasive ventilation in severe acute asthma Respiratory care 2010 May. Pp 536-543
- Soma et al A prospective and randomised study for improvement of acute asthma by non-invasive positive pressure ventilation. (NIPPV) Internal medicine 2008 pp 493-501
- Soroksky et al A pilot prospective randomised placebo-controlled trial of bi level positive airway pressure in acute asthma attack Chest journal 2003 pp 1018