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Subarachnoid hemorrhage in a child with status asthmaticus: significance of permissive hypercapnia

Suzanne M Edmunds1, Rick Harrison

  • 1Department of Pediatric Critical Care, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|March 27, 2003
PubMed

Insights

A case report details an 11-year-old boy with severe asthma who developed a subarachnoid hemorrhage while undergoing treatment with permissive hypercapnia. This rare complication highlights a potential association between this respiratory management strategy and intracranial bleeding.

Area of Science:

  • Pediatric Intensive Care Medicine
  • Neurology
  • Respiratory Medicine

Background:

  • Severe asthma exacerbations in children can necessitate intensive care management.
  • Permissive hypercapnia is a strategy used to manage respiratory failure in severe asthma, allowing for higher carbon dioxide levels.
  • Subarachnoid hemorrhage is a serious neurological event characterized by bleeding in the space surrounding the brain.

Observation:

  • An 11-year-old boy with acute status asthmaticus was managed with mechanical ventilation and permissive hypercapnia.
  • The patient developed neurological changes, including altered pupillary response.
  • Brain imaging confirmed diffuse subarachnoid hemorrhage.

Findings:

  • Extensive investigations, including carotid angiography, did not identify an underlying vascular malformation or other predisposing factors for the hemorrhage.
  • The subarachnoid hemorrhage occurred during the course of managing severe asthma with permissive hypercapnia.

Implications:

  • This case suggests a potential association between permissive hypercapnia and the development of subarachnoid hemorrhage in pediatric patients with severe asthma.
  • Further research is warranted to understand the pathophysiology and incidence of this complication.
  • Clinicians should be vigilant for neurological changes in pediatric asthma patients managed with permissive hypercapnia.
Abstract

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