Does non-invasive ventilation improve patient outcome or relive symptoms in acute asthma attacks
Date First Published:
April 4, 2016
Last Updated:
May 25, 2016
Report by:
David Jeffrey, Resuscitation officer (GG&C)
Search checked by:
David Jeffrey, GG&C
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 searches
Search Details:
Key words used asthma, NIV, Non-invasive ventilation. searches comined using and/ or selection limited to English, Adult, human.
Outcome:
74 articles in initial results.
duplicates removed. Titles read and then abstracts from relevent titles.
4 RCTs identified for review.
duplicates removed. Titles read and then abstracts from relevent titles.
4 RCTs identified for review.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma Brandao et al 2009 Brazil | Adults aged 18-65 admitted with acute severe asthma | Randomised control trial | Intervention group showed an increase in PEF FCV AND FEV when compared with the control group | ||
| A prospective randomised control trial on the efficacy of noninvasive ventilation in severe acute asthma 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 |
| A prospective and randomised study for improvement of acute asthma by non-invasive positive pressure ventilation. (NIPPV) 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 |
| A pilot prospective randomised placebo-controlled trial of bi level positive airway pressure in acute asthma attack 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. |
Author Commentary:
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.
Bottom Line:
NIV could reduce LOS IN ICU and hospital in patients with acute severe asthma
References:
- Brandao et al. Reversal of bronchial obstruction with bi-level positive airway pressure and nebulization in patients with acute asthma
- Gupta et al. A prospective randomised control trial on the efficacy of noninvasive ventilation in severe acute asthma
- Soma et al. A prospective and randomised study for improvement of acute asthma by non-invasive positive pressure ventilation. (NIPPV)
- Soroksky et al. A pilot prospective randomised placebo-controlled trial of bi level positive airway pressure in acute asthma attack