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Isoflurane therapy for severe refractory status asthmaticus in children
Venkat Shankar1, Kevin B Churchwell, Jayant K Deshpande
1Monroe Carrell Jr. Children's Hospital at Vanderbilt, Division of Pediatric Critical Care Medicine, 5121 B Doctor's Office Tower, TN 37232-9075, Nashville, Tennessee, USA. venkat.shankar@vanderbilt.edu
Insights
Inhaled isoflurane improved blood gases and aided ventilation weaning in children with severe asthma. While generally effective, hypotension was a notable side effect requiring management.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Anesthesiology
Background:
- Life-threatening asthma in children presents significant management challenges.
- Mechanical ventilation is often required for severe asthma exacerbations.
- Limited treatment options exist for refractory status asthmaticus.
Purpose of the Study:
- To evaluate the efficacy and safety of inhaled isoflurane in pediatric patients with severe asthma.
- To describe the physiological effects of isoflurane in mechanically ventilated children.
Main Methods:
- Retrospective case series conducted in a pediatric intensive care unit.
- Involved 10 children (ages 1-16 years) with 11 episodes of severe asthma requiring mechanical ventilation.
- Analyzed physiological parameters and clinical outcomes following inhaled isoflurane administration.
Main Results:
- Isoflurane administration improved arterial pH and reduced PaCO2 in all 11 episodes.
- Sustained clinical improvement and successful weaning from mechanical ventilation occurred in 10 cases.
- Hypotension was observed in 8 children, requiring vasopressor support; one patient died from prior anoxic injury.
Conclusions:
- Inhaled isoflurane is an effective treatment for improving gas exchange in mechanically ventilated children with life-threatening status asthmaticus.
- Isoflurane offers a potential therapeutic option for severe asthma refractory to conventional management.
- Careful monitoring for side effects like hypotension is crucial during isoflurane therapy.
Objective:
To describe the use of inhaled isoflurane in a series of children with life-threatening asthma.
Design:
Retrospective case series.
Setting:
Pediatric intensive care unit of a tertiary-care children's hospital. Ten children ranging in age from 1 to 16 years with 11 episodes of severe asthma requiring invasive mechanical ventilation in the pediatric intensive care unit over a 5-year period.
Results:
Isoflurane resulted in an improvement in arterial pH and a reduction in partial pressure of arterial carbon dioxide (PaCO(2)) in all the 11 instances. This effect was sustained in 10 cases and led to clinical improvement and rapid weaning from mechanical ventilation. One child failed to show sustained response and was placed on veno-venous extracorporeal membrane oxygenation. One child died secondary to anoxic brain injury sustained prior to hospitalization. Hypotension was the major side effect, and occurred in 8 children necessitating vasopressor support.
Conclusions:
Isoflurane improves arterial pH and reduces partial pressure of arterial carbon dioxide in mechanically ventilated children with life-threatening status asthmaticus who are not responsive to conventional management.
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