Correct!
5. All of the above

The principles of mechanical ventilation in asthma are (2):

• Avoid further dynamic hyperinflation.
• Reduce auto PEEP
• Enough sedation and consider neuromuscular blockade
• Allow permissive hypercapnia

Pressure controlled ventilation is the preferred mode of mechanical ventilation with a tidal volume of 6-8 ml/kg, a respiratory rate of 10-14 breaths/min, PEEP of 0-5 cm H2O, with a plateau pressure of <30 cm H2O.

At this time the Centers for Disease Control is recommending oseltamivir, zanamivir, or peramivir for patients suspected of potentially having influenza (3). Our patient eventually proved to be influenza A + and was treated with oseltamivir for 5 days.

The patient underwent a trial of general anesthesia with isoflurane (4, 5). Unfortunately, this made little difference. The arterial blood gases remained poor with a pH 7.09, pCO2 109 mm Hg, and pO2 113 mm Hg on 60% FiO2.

What additional therapies could be attempted for severe asthma? (Click on the correct answer to proceed to the last panel)

1. Extracorporeal membrane oxygenation (ECMO)
2. Heliox
3. Ketamine
4. 1 and 3
5. All of the above

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