ICU · Respiratory

Acute severe asthma in the ICU (status asthmaticus)

Also known as Status asthmaticus · Near-fatal asthma · Severe acute asthma · Magnesium sulphate for asthma · Volatile anaesthetic agents for asthma · Permissive hypercapnia · Dynamic hyperinflation / breath-stacking · Heliox in asthma

Status asthmaticus is severe acute asthma unresponsive to standard bronchodilator therapy. Features of life-threatening asthma: silent chest, exhaustion or drowsiness with hypercapnia, hypoxaemia (SpO2 <90% on ambient air), normal or rising PaCO2. Management: controlled oxygen (target SpO2 93-95% in asthma), repeated or continuous nebulised salbutamol + ipratropium, IV magnesium sulphate (2g over 20min), early systemic corticosteroids (prednisone 1mg/kg/day up to 50mg; oral and IV similarly effective). Mechanical ventilation: if required, use PERMISSIVE HYPERCAPNIA (small tidal volumes 6-8mL/kg IBW, low respiratory rate 10-12, long expiratory time, plateau pressure under 30 cmH2O) to avoid dynamic hyperinflation. Volatile anaesthetics (sevoflurane) as last-line bronchodilators. VV-ECMO for refractory near-fatal asthma - 83.5% survival in the ELSO registry analysis.

Checked against its sources on 3 Sept 2026