Saturday, October 1, 2011

A case of Unresolved Status Asthmaticus

A 29 year old, 80 kg male patient, known asthamatic since childhood on irreg medications, admitted to our hospital with cough, cold since 2 days, n breathlessness of 1 day duration. Patient nebulised, inf aminophylline, iv steroids given. No relief. Raised pCO2, low pO2-intubated n ventilated. Kept deeply sedated, paralysed.
Post ventilation intrinsic PEEP of 18cm H2O. pCO2 of 92mmHg. Low RR, low TV, high expiratory time ventilation. Tracheal secretions thick, purulent. Blood inv- TLC 15000. PCT<0.5. Treated with IV antibiotics (Imipenem, Linezolid, Claribid, Tamiflu) , infusion doxophylline, iv solumedrol, Nebulisation with salbutamol, Ipravent, Budecort; s/c Terbutaline.
48 hours later, persistent spasm, Intrinsic PEEP 11 cm H2O, pCO2=60 mmHg.
Please post your suggestions...