Emergency Medicine

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Title: The Critically Ill Asthmatic Patient

Category: Critical Care

Posted: 11/2/2021 by Mike Winters, MBA, MD (Updated: 3/3/2026)

Initial Mechanical Ventilation Settings for the Intubated Asthmatic

  • Approximately 2% of adult patients who present with an acute asthma exacerbation will require intubation and mechanical ventilation.
  • It is critical to provide the intubated asthmatic with sufficient time for exhalation.
  • Initial recommended settings for mechanical ventilation include:
    • Tidal volume: 6-8 ml/kg ideal body weight
    • Respiratory rate: 6-10 breaths per minute
    • PEEP: 0-5 cm H2O
    • Inspiratory flow rate: 80-120 L/min
  • Permissive hypercapnea is tolerated to a pH of approximately 7.15

References

Long B, et al. Evaluation and management of the critically ill adult asthmatic in the emergency department setting. Am J Emerg Med. 2021;44:441-51.