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Volatile anesthetic agents for life-threatening pediatric asthma: A multicenter retrospective cohort study and
Alicia Lew1, John M Morrison2, Ernest K Amankwah2,3
1Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.
Insights
Volatile anesthetics did not reduce ventilation duration or mortality in critically ill children with asthma. While not improving outcomes, they did not increase adverse events, suggesting further research is needed for this rescue therapy.
Area of Science:
- Pediatric Intensive Care
- Respiratory Medicine
- Anesthesiology
Background:
- Volatile anesthetic agents are considered for invasive ventilation in pediatric critical asthma.
- Existing data are limited to case series, necessitating further investigation.
Purpose of the Study:
- To assess the impact of volatile anesthetic exposure on ventilation duration and mortality in invasively ventilated children with severe asthma.
- To compare outcomes between children exposed and not exposed to volatile anesthetics.
Main Methods:
- A multicenter retrospective cohort study of children aged 5-17 years requiring invasive ventilation for asthma (2013-2019).
- Compared outcomes (ventilation duration, mortality, length of stay, adverse events) between children with and without volatile anesthetic exposure.
- Included subgroup analysis for children ventilated for ≥2 days.
Main Results:
- No significant difference in mortality was observed between groups.
- Children exposed to volatile anesthetics had longer ventilation duration and length of stay.
- Increased odds of extracorporeal life support were noted in the volatile anesthetic group, even in subgroup analysis.
- No cases of malignant hyperthermia or hepatic failure were reported.
Conclusions:
- Volatile anesthetic exposure did not alter mechanical ventilation duration or mortality in pediatric asthma patients.
- While potentially a viable rescue therapy, definitive prospective trials are required to confirm efficacy and safety.
- Current findings suggest cautious consideration for volatile anesthetic use in this population.
Background:
Volatile anesthetic agents are described as rescue therapy for children invasively ventilated for critical asthma. Yet, data are currently limited to case series.
Aims:
Using the Virtual Pediatric Systems database, we assessed children admitted to a pediatric intensive care unit invasively ventilated for life-threatening asthma and hypothesized ventilation duration and mortality rates would be lower for subjects exposed to volatile anesthetics compared with those without exposure.
Methods:
We performed a multicenter retrospective cohort study among nine institutions including children 5-17 years of age invasively ventilated for asthma from 2013 to 2019 with and without exposure to volatile anesthetics. Primary outcomes were ventilation duration and mortality. Secondary outcomes included patient characteristics, length of stay, and anesthetic-related adverse events. A subgroup analysis was performed evaluating children intubated ≥2 days.
Results:
Of 203 children included in study, there were 29 (14.3%) with and 174 (85.7%) without exposure to volatiles. No differences in odds of mortality (1.1, 95% CI: 0.3-3.9, p > .999) were observed. Subjects receiving volatiles experienced greater median difference in length of stay (4.8, 95% CI: 1.9-7.8 days, p < .001), ventilation duration (2.3, 95% CI: 1-3.3 days, p < .001), and odds of extracorporeal life support (9.1, 95% CI: 1.9-43.2, p = .009) than those without volatile exposure. For those ventilated ≥2 days, no differences were detected in mortality, ventilation duration, length of stay, arrhythmias, or acute renal failure. However, the odds of extracorporeal life support remained greater for those receiving volatiles (7.6, 95% CI: 1.3-44.5, p = .027). No children experienced malignant hyperthermia or hepatic failure after volatile exposure.
Conclusions:
For intubated children for asthma, no differences in mechanical ventilation duration or mortality between those with and without volatile anesthetic exposure were observed. Although volatiles may represent a viable rescue therapy for severe cases of asthma, definitive, and prospective trials are still needed.
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