Rapid Sequence Intubation for Status Asthmaticus.
- Preoxygenation (as possible) 100% oxygen for 3 min or eight vital capacity breaths, or highest flow oxygen possible
- Pretreatment—albuterol, 2.5 mg nebulized, or lidocaine, 1.5 mg/kg
- Paralysis with induction:
- Ketamine, 1.5 mg/kg
- Succinylcholine, 1.5 mg/kg
Ketamine has bronchodilatory properties and may mitigate bronchospasm in patients who are not intubated and in patients who are already intubated and are not improving with mechanical ventilation. Ketamine is also a reasonable induction agent for the emergency intubation of patients with status asthmaticus.
- Postintubation management:
- Sedation and analgesia
- Neuromuscular blocking agent only if required after adequate sedation, analgesia
- In-line albuterol nebulization
- Additional ketamine as indicated
High-dose, inhaled β-agonists, such as albuterol,
provide maximal protection against reactive bronchospasm
during intubation and are indicated for asthmatics with or
without active bronchospasm.
