UMEM Educational Pearls

Title: The Critically Ill Asthmatic Patient

Posted: 11/2/2021 by Mike Winters, MBA, MD (Updated: 11/22/2024)
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Initial Mechanical Ventilation Settings for the Intubated Asthmatic

Approximately 2% of adult patients who present with an acute asthma exacerbation will require intubation and mechanical ventilation.
It is critical to provide the intubated asthmatic with sufficient time for exhalation.
Initial recommended settings for mechanical ventilation include:
- Tidal volume: 6-8 ml/kg ideal body weight
- Respiratory rate: 6-10 breaths per minute
- PEEP: 0-5 cm H2O
- Inspiratory flow rate: 80-120 L/min
Permissive hypercapnea is tolerated to a pH of approximately 7.15

Long B, et al. Evaluation and management of the critically ill adult asthmatic in the emergency department setting. Am J Emerg Med. 2021;44:441-51.