Monitoring the Resolution of Acute Exacerbation of Airway Bronchoconstriction in an Asthma Attack Using Capnogram Waveforms

Mio Shikama, MD; Miyuki Yamamoto, MD, PhD; Itsuki Osawa, MD; Takuya Sato, MD; Ichiro Hirayama, MD, PhD; Naoki Hayase, MD, PhD; Takehiro Matsubara, MD, PhD; Kent Doi, MD, PhD

doi:10.1097/CCE.0000000000000899

Critical Care Explorations (Apr 2023)

Monitoring the Resolution of Acute Exacerbation of Airway Bronchoconstriction in an Asthma Attack Using Capnogram Waveforms

Mio Shikama, MD,
Miyuki Yamamoto, MD, PhD,
Itsuki Osawa, MD,
Takuya Sato, MD,
Ichiro Hirayama, MD, PhD,
Naoki Hayase, MD, PhD,
Takehiro Matsubara, MD, PhD,
Kent Doi, MD, PhD

Affiliations

Mio Shikama, MD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Miyuki Yamamoto, MD, PhD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Itsuki Osawa, MD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Takuya Sato, MD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Ichiro Hirayama, MD, PhD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Naoki Hayase, MD, PhD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Takehiro Matsubara, MD, PhD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Kent Doi, MD, PhD: All authors: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.

DOI: https://doi.org/10.1097/CCE.0000000000000899
Journal volume & issue: Vol. 5, no. 4
p. e0899

Abstract

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BACKGROUND:. Patients with acute bronchospasm can show a distinct slope of the capnogram (“shark fin”) as a result of asynchronous alveolar excretion. Although the slope of the upward alveolar plateau (phase III) in the capnogram waveforms of non-intubated patients is known to help monitor the therapeutic response to acute bronchospasm, little is known about the significance of its slope among intubated patients. Therefore, we quantified the phase III slope of an intubated patient with acute asthma to investigate whether capnogram waveforms could be useful for identifying the response to antibronchospasm treatment in real time. CASE SUMMARY:. The patient was a 53-year-old man who had a history of asthma. He presented to the emergency department with the primary complaint of respiratory distress. He was diagnosed with severe asthma attack and required invasive mechanical ventilation for 10 days, during which we quantified the phase III slope of the capnogram. The phase III slope decreased during treatment, with a significant reduction from the third to the fourth day; however, a significant decrease in end-tidal carbon dioxide (EtCO2) was observed from the fifth to the sixth day. We found that the slope values decreased earlier than EtCO2 reduction, although the absolute EtCO2 values eventually decreased in response to antibronchospasm treatment. CONCLUSION:. There were several reports that evaluated the phase III slope in non-intubated patients with asthma, but this is the first report measuring the phase III slope in an intubated patient over several days. Capnogram waveforms may serve as useful real-time indicators to monitor acute bronchospasm among mechanically ventilated patients.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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