Evaluación del paciente con crisis aguda severa de asma bronquial en la unidad de emergencia
Palabras clave:
asma, cuidados críticos, adultoResumen
Los altos niveles de prevalencia del asma a nivel mundial y el incremento de su morbimortalidad en las últimas décadas, constituyen un importante problema de salud pública. La evaluación y el tratamiento del paciente con crisis aguda de asma bronquial en la sala de emergencias son los pasos necesarios para lograr el buen manejo de la enfermedad. En este artículo se realizó una revisión bibliográfica acerca del tema para señalar algunos aspectos importantes de la evaluación y manejo de este tipo de paciente. Se identificaron los elementos clínicos y de función pulmonar, fundamentalmente el flujo espiratorio pico (PEF), que tienen valor pronóstico, por lo cual, se recomendó el uso de estas medidas objetivas de la obstrucción de la vía aérea para establecer criterios de predicción y orientar un seguimiento mas estrecho de los pacientes afectados.
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Antó JM, Sabriá J. Epidemiología del asma bronquial. En: Roca J. Asma Bronquial. Barcelona: Doyma, 1993.p.117-36.
Anuario Estadístico. Ciudad Habana: Ministerio de Salud Pública; 1999.
Jackson R, Sears M, Beaglehole R, Rea H. International trends in asthma mortality 1970 to 1985. Chest 1988; 94: 914-8.
Levy B, Kitch B, Fanta C. Medical and ventilatory management of status asthmaticus. Intensive Care Med 1998; 24: 105-7.
Sly RM.Changing asthma mortality. Ann Allergy 1994; 73(3): 259-68.
Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992; 326: 862-6.
McFadden ER, Warren EL. Observations on asthma mortality. Ann Intern Med 1997; 127: 142-7.
Mac Donald JB, Mac Donald ET, Seaton A, Williams DA. Asthma deaths in Cardiff 1963-74: 53 deaths in hospital. BMJ 1976; 2: 721-3.
Wasserfallen JB, Schaller MD, Feihl F, Perret CH. Suden asphyxic asthma: a distinct entity?. Am Rev Respir Dis 1990; 142: 108-11.
Sly RM. Mortality from asthma 1979-1984. J Allergy Clin Inmunol 1988; 82: 705-17
Sly RM. Mortality from asthma in children 1974-1984. Ann Allergy 1988; 60: 433-43.
Rothwell RP, Rea HH, Sears MR, Beaglehole R, Gillies AJ, Holst PE et al. Lessons from the national asthma mortality study: deaths in hospitals. N Z Med J 1987; 100: 199-202.
Barger LW, Vollmer WM, Felt RW, Buist AS. Further investigation into the recent increase in asthma deaths rates: a review of 41 deaths in Oregon in 1982. Ann Allergy 1988; 60: 31-9.
Fanta CH, Israel E, Sheffer Al. Managing and preventing severe asthma attacks. J Respir Dis 1993; 13: 94-108.
Dales RE, Schweitzer I, Kerr P et al. Risk factors of the recurrent emergency department visits for asthma. Thorax 1995; 50: 520-4.
Reed S, Diggle S, Cushley MJ, Sleet RA, Tattersfield AE. Assessment and management of asthma in a accident and emergency department. Thorax 1985; 40: 897-902.
Daley JD, Kopelman RI, Comeau E, Ginns LC, Rossing TH. Practice patterns in the treatment of acutely ill hospitalized asthmatic patients at three teaching hospitals. Chest 1991; 100: 51-6.
Spevetz A, Bartter T, Dubois J, Pratter MR. Impatient management of status asthmaticus. Chest 1992; 102: 1392-6.
Robertson CF, Rubinfeld AR, Bowes G. Pediatric asthma deaths in Victoria: the mild area of risk. Pediatr Pulmonol 1992; 13: 95-100.
Foucard T, Graff-Lonnevig V. Asthma mortality rate in Swedish children and young adults 1973-88. Allergy 1994; 49: 616-9.
Rea HH, Scragg R, Jackson R, Beaglehole R, Fenwick J, Sutherland DC. A case-control study of deaths from asthma. Thorax 1986; 41: 833-9.
Sears MR, Rea HH, Rothwell RP, O'Donnell TV, Holst PE, Gillies AJ et al. Asthma mortality: comparison between New Zealand and England. BMJ 1986; 293: 1342-5.
Buist AS, Vollmer WM. Preventing deaths from asthma. N Engl Med J 1994; 331: 1584-5.
Brenner BE, Abraham E, Simon RR. Position and diaphoresis in acute asthma. Am J Med 1983; 74: 1005-9.
Edelson JD, Rebuck AS. The clinical assessment of severe asthma. Arch Inter Med 1985; 145: 321-3.
Rebuck AS, Read J. Assessment and management of severe asthma. Am J Med 1971; 51: 788.
Knowles G, Clark TJH. Pulsus paradoxus as a valuable sign indicating severity of asthma. Lancet 1973; 2: 1356-9.
Permutt S, Wise RA. Mechanical interactions of respiration and circulation. En: Fishman A, editor. Handbook of Physiology. Baltimore: Williams and Wilkins, 1986; Vol 3.p. 647-62.
Pearson MG, Spencer DP, Ryland I, Harrison BDW. Value of pulsus paradoxus in assessing acute severe asthma. BMJ 1993; 307: 659.
British Asthma Guidelines Coordinating Committe. British guidelines on asthma management: 1995 review and position statement. Thorax 1997; 52: S1-21.
Shim CS, Williams MH. Evaluation of the severity of asthma: patients versus physicians. Am J Med 1980; 68: 11-3.
Rodrigo C, Rodrigo G. Early administration of hidrocortisone in the emergency room treatment of acute asthma:a controlled clinical trial. Resp Med 1994; 88: 755-61
. Kelsen SG, Kelsen DP, Fleegler BF, Jones RC, Rodman T. Emergency room assessment and treatment of patients with acute asthma. Lancet 1967; 1: 644-6.
Tai R, Read J. Blood-gas tensions in bronchial asthma. Lancet 1967; 1: 644-6.
Jardin F, Barthelemy M. Frequénce de l'acidose métabolique au cours de létat mal asthmatique de ládulte. Nouv Presse Med 1977;6: 329-32.
Weng TR, Langer HM, Featherby EA, Levison H. Arterial blood gas tensions and acid-base balance in symptomatic and asymptomatic asthma in childhood. Am Rev Respir Dis 1970; 101: 274-82.
Carruthers DM, Harrinson BDW. Arterial blood gases analysis or oxygen saturation in the assessment of acute asthma?. Thorax 1995; 50: 186-8.
Findley LJ, Sahn SA. The value of chest roentgenograms in acute asthma in adults. Chest 1980; 5: 535-6.
.Lavechia V, Rodrigo C, Maraffi L, Rodrigo G. Valor de la radiografía de tórax en pacientes asmáticos agudos que consultan en un servicio de emergencia. Pac Crítico 1992; 5: 128- 32.
Katz DN. The mini-Wright peak flow meter for evaluation airway obstruction in a family practice. J Fam Pract 1983; 17: 51-7.
Friedman M, Walker S. Assessment of lung function using airflow meter. Lancet 1975; 1: 310-1.
Paggiaro PL, Moscato G, Gianninni D, Di Franco A, Gherson G. Relationship between peak expiratory (PEF) and FEV1. Eur Respir J 1997; 10(Suppl): 39-41.
Nowak RM, Pensler MI, Sarkar DD, Anderson JA, Kvale PA, Ortiz AE et al. Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma. Ann Emerg Med 1982; 11: 64-9.
Rodrigo C, Rodrigo G. Comparación entre el pico de flujo espiratorio y el volumen
espiratorio forzado en el primer segundo en pacientes en crisis asmática. Rev Med Uruguay 1994; 10: 15-9.
Shapiro SM, Hendler JM, Ogirala RG, Aldrich TK, Shapiro MB. An evaluation of the accuracy of assess and mini-Wright peak flowmeters. Chest 1991; 99: 358-62.
Gardner RM, Crapo RO, Jackson BR, Jensen RL. Evaluation of accuracy and reproductibility of peak flow-meters at 1400 m. Chest 1992; 101: 948-52.
National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the diagnosis and manegement of asthma. Bethesda, Maryland: NHI, 1997. Publication 55- 4051.
Banner AS, Shah RS, Addington WW. Rapid prediction of need for hospitalization in acute asthma. JAMA 1976; 235: 1337-8.
Rodrigo G, Rodrigo C. Tratamiento de la crisis asmática: comparación entre fenoterol y salbutamol en altas dosis administradas con inhalador de dosis medida con inhalocámara (Volumatic) y aminofilina intravenosa. Pac Crítico 1991; 4: 194-209.
Fanta CH, Rossing TH, McFadden Jr ED. Emergency room treatment of asthma: relationships among therapeutic combinations, severity of obstruction and time course of response. Am J Med 1982; 72: 416-22.
Nowak RM, Tomlanovich MC, Sarkar DD, Kvale PA, Anderson JA. Arterial blood gases and pulmonary function testing in acute bronchial asthma. JAMA 1983; 249: 2043-6.
Stein LM, Cole RP. Early administration of corticosteroids in emergency room treatment of acute asthma. Ann Intern Med 1990; 112: 822-7.
McFadden ER, Kiser R, DeGroot W. Acute bronchial asthma: relationship between clinical and physiological manifestations. N Eng J Med 1973; 288: 221-5.
Fischl MA, Pitchenik A, Gardner LB. An index predicting relapse and need for hospitalization in patients with acute bronchial asthma. N Engl J Med 1981; 305: 783-9.
Rose CC, Murphy JG, Schwartz JS. Performance of an index predicting the response of patients with acute bronchial asthma to intensive emergency department. N Engl J Med 1984; 310: 573-7.
Centor RM, Yarbrough B, Wood JP. Inability to predict relapse in acute asthma. NEngl J Med 1984; 310: 577-80.
Mc Carren M, McDermot MF, Zalensky RJ, Ovanonic B, Marder D, Murphy DG et al. Prediction of relapse within eight weeks after an acute asthma exacerbation in adults. J Clin Epidemiol 1998; 51: 107-18.
Rodrigo G, Rodrigo C. Early prediction of poor response acute asthma patientes in the emergency department. Chest 1998; 114(4): 1016-21.
Rodrigo G, Rodrigo C. A new index for early prediction of hospitalization in patients with acute asthma. Am J Emerg Med 1997; 15: 8-13.
Brenner B, Kohn M. The acute asthmatic patient in the ED: to admit or discharge. Am J Emerg Med 1998; 16: 69-75.
