This RAGEback includes commentary and reaction to the RAGE Session Three discussion of severe life-threatening acute asthma. It features comments from Mary Shue on THAM, Greg Miller on lignocaine and someone called Scott Weingart (anyone heard of him?) on non-invasive ventilation.
Here’s some stuff on lignocaine (a fairly evidence free zone!):
- BestBets: Lignocaine as a pretreatment to Rapid Sequence Induction of patients with Status Asthmaticus
- Maslow AD, Regan MM, Israel E, Darvish A, Mehrez M, Boughton R, Loring SH. Inhaled albuterol, but not intravenous lidocaine, protects against intubation-induced bronchoconstriction in asthma. Anesthesiology. 2000 Nov;93(5):1198-204. PubMed PMID: 11046206. [Free Full Text]
- More recently though, this paper suggested some beneficial effects on bronchoconstriction post-intubation:
Adamzik M, Groeben H, Farahani R, Lehmann N, Peters J. Intravenous lidocaine after tracheal intubation mitigates bronchoconstriction in patients with asthma. Anesth Analg. 2007 Jan;104(1):168-72. PubMed PMID: 17179265.
Some stuff by Scott Weingart on Emcrit.org relevant to this discussion:
- EMCrit Podcast 15 — The Severe Asthmatic
- EMCrit Podcast 19 — Non-invasive Ventilation
- EMCrit Podcast 40 — Delayed Sequence Intubation (DSI)
Finally, some useful links from the LITFL Critical Care Compendium:
- LITFL CCC — Alkali Therapies
- LITFL CCC — Non-invasive ventilation (NIV) and asthma
- LITFL CCC — Pretreatment drugs for Rapid Sequence Intubation (RSI)
Thanks again for listening to the RAGE!