3 thoughts on “Does Noninvasive Positive-Pressure Ventilation Improve Outcomes in Severe Asthma Exacerbations?”

  1. You know, I’ve had this feeling for many years about “unmeasurable outcomes”….for example, just because being nice to Aunt Minnie in the back of the ambulance can’t be shown to improve hospital survival, it doesn’t mean that you shouldn’t do it. I think that there’s a bit of this in the use of CPAP/BiPAP in patients with respiratory distress. I think that a bit of positive pressure support on these patients getting fatigued – having taken care of them by the hundreds in our system – our distinct impression is that the patients are more comfortable, more able to relax, and seem to generally make more steady and predictable improvement. It may be that these outcomes are difficult to measure, but I know that we reach for pressure support – both pre-hospital and in the ED – without hesitation…..the sooner the better. I’m hoping that we’ll even have some of the disposable CPAP’s in the ED so that we can just “put ’em right on” without hesitation.

    Just my two cents…

  2. Why, No. I would guess that they didn’t, because that’s subjective (and therefore not scientific), unless we can “objectivize” it by, hmm, assigning a NUMBER! That’s objective. Let’s have them pick a number from a Likert scale (and make them feel awkward by having to choose). If we get enough Likert numbers, then we have “data!” (Of course, this is sarcasm, and not related to the named studies.)

    Seriously, most studies on breathing Helium-Oxygen mixtures are inconclusive, or can not attribute benefit in outcome or Length of Stay, etc. Yet, as exampled above, the patients are happier with their work of breathing lessened, no longer frightened, and vital signs moderate. I’ve seen maxed-out patients, not tolerating NIV mask, about to be tubed, avoid the tube entirely to discharge.

    It’s not possible to “standardize variables” for an RCT in dynamic and critical patients.

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