Isoflurane therapy for status asthmaticus in children: A case series and protocol

OBJECTIVE: To describe the use of inhaled isoflurane by using a standardized protocol in the treatment of respiratory failure secondary to status asthmaticus in a series of pediatric patients. DESIGN: Case series. SETTING: Pediatric intensive care unit of a tertiary care military medical facility. PATIENTS: Six pediatric patients ranging in age from 14 months to 15 yrs who were treated with isoflurane in our pediatric intensive care unit for status asthmaticus from 1995 to 1998. INTERVENTION: Inhaled isoflurane therapy was initiated by using the treatment protocol after the patients had failed conventional medical management in the treatment of their asthma. MEASUREMENTS AND MAIN RESULTS: All patients tolerated isoflurane therapy well by using our standardized protocol in conjunction with careful hemodynamic monitoring and support. The administration of inhaled isoflurane resulted in measurable improvements in the subject patients, as evidenced by statistically significant decreases in Paco2 and peak inspiratory pressures, as well as a significant increase in pH. All six patients were successfully extubated and were discharged from the hospital without apparent sequelae. CONCLUSIONS: We conclude isoflurane may be a safe, effective treatment modality in the management of status asthmaticus refractory to aggressive medical therapy, although further study is warranted. We emphasize this mode of therapy should be instituted only after traditional treatment modalities have failed and appropriate intensive care support is available.