Case review to highlight unique needs of patients with asthma in the ICU

Alice Gallo De Moraes, MD
Alice Gallo De Moraes, MD

When adult patients in the ICU need mechanical ventilation, it’s rarely because of an acute asthma exacerbation. Because of the infrequency of this condition, critical care clinicians may appreciate a refresher on best treatment practices for such clinical situations—especially as allergy and infection risks increase with the approach of fall and winter.

CHEST 2022 will offer that review during the panel discussion, Asthma in the ICU: A Choose Your Own Adventure Case-Based Review, Wednesday, October 19, from 2:15 PM – 3:15 PM CT, in Room 104BC. The session will use clinical cases to stimulate discussion about the medical treatments and strategies for noninvasive and invasive ventilation management that best suit the needs of individuals with acute asthma.

“We’re hoping we can share our knowledge on the best practical approach to the asthmatic patient in the ICU,” said Alice Gallo De Moraes, MD, pulmonary and critical care specialist at the Mayo Clinic in Rochester, MN, who will chair the session and give one of the talks.

“We want to encourage our colleagues to review medications that might be helpful to asthma patients who need mechanical ventilation, such as continuous nebulized bronchodilation and magnesium infusions to help with bronchospasm,” Dr. Gallo De Moraes said. “Even the medications we choose to sedate patients with acute asthma might be different in the sense that we have to consider some that are not first-line for most adults but should be in this population because they contribute to bronchodilation.”

The discussion, which will encourage audience participation, will be relevant to anyone who takes care of adult patients in an ICU, she said.

Dr. Gallo De Moraes will address the topic of mechanical ventilation involving intubation. Justin Rearick, RRT, MS, a registered respiratory therapist who manages the department of respiratory care at Connecticut Children’s Medical Center, will discuss mechanical ventilation delivered noninvasively through a mask. And Meredith Greer, MD, pulmonology and sleep medicine specialist at Emory Healthcare in Atlanta, will discuss pharmacologic treatment, focusing on the best timing for bronchodilators and the wisdom of treating pain and anxiety with medications for which side effects include bronchodilation, such as ketamine.

Ultimately, the speakers intend to make clear how different treatment approaches can work together to help this population of patients who are typically admitted to the ICU after being exposed to a trigger, often in an environment that is new to them and without having easy access to their rescue medication.

“Some patients will need intubation,” Dr. Gallo De Moraes said, “but the appropriate medications and noninvasive mechanical ventilation might be all that some of them need.”

Dr. Gallo De Moraes said she is looking forward to the panel discussion for several reasons, including the opportunity to fulfill her role as a clinician educator.

“I believe this session is going to remind our colleagues of the nuances of treating adults with asthma in the ICU,” she said. “I’m also excited to learn from Dr. Greer and Justin Rearick, who are experienced and engaging educators.”