La Revue du praticien
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A severe acute asthma attack is defined by the presence of clinical signs of severity and/or a value of peak expiratory flow (PEF) < 30% predicted. The treatment is based mainly on inhaled beta 2 agonists and systemic corticosteroids. Nebulization is the route of administration of choice, because of its simplicity, its efficacy and its tolerability. ⋯ The great majority of deaths from acute asthma are avoidable, underlining the importance of preventive measures. Prevention is based on the control of the asthma by personalized ongoing treatment based on long-term inhaled corticosteroids and the use of oral corticosteroids in the treatment of exacerbations. However, a severe acute asthma attack can appear at any stage of severity of asthma, including controlled asthma, justifying the utilisation of action plans to treat exacerbations.
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La Revue du praticien · May 2003
Review[Non-invasive ventilation for acute respiratory insufficiency].
Non-invasive ventilation provides ventilatory support to patients admitted for acute respiratory failure, without the need for endotracheal intubation or tracheostomy. Most of the times, a full face mask covering both the nose and the mouth is used. This technique is mainly delivered in intensive care departments, but tends to spread to emergency departments, respiratory wards or pre-hospital settings. ⋯ It is particularly successful for patients suffering from acute exacerbation of chronic obstructive pulmonary disease and in asphyxic forms of cardiogenic pulmonary oedema. In these indications, non-invasive ventilation reduces the need for intubation, improves hospital length of stay and outcome. Other forms of acute hypoxemic respiratory failure with isolated lung failure can also benefit from this technique.
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Acute respiratory distress syndrome (ARDS) is a non cardiogenic pulmonary edema that results from several pulmonary or extrapulmonary insults. ARDS respiratory manifestations, in fact, represent the expression of a complex and diffuse inflammatory process involving other organs. ⋯ Since mechanical ventilation, itself, could promote lung injury, a ventilatory strategy combining both, low volumes to limit distension and positive end expiratory pressure to recruit atelectasis may be beneficial. This hypothesis has been recently confirmed in a study involving more than 800 patients, demonstrating that a simple ventilatory strategy based on recent physiological knowledge may affect ARDS outcome.