Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?

1. Allow peak inspiratory pressures to go as high as required.
2. Permissive hypercapnia.
3. Prolonged inspiratory time.
4. Small tidal volumes.
a. 1, 2, and 3 only
b. 2 and 4 only
c. 3 only
d. 2, 3, and 4 only

ANS: B
Patients with severe asthma and respiratory failure (hypoxia, hypercapnia, and increased work of breathing) need ventilatory support and present special challenges. Mortality rates for these pa-tients can be as high as 22%, and complications are common, especially barotrauma. These com-plications can be minimized by limiting peak inspiratory pressure to less than 50 cm H2O and by the use of small tidal volumes, allowing "permissive hypercapnia" if necessary.