AN UNEXPECTED TRIAL: SEVOFLURANE USE IN STATUS ASTHMATICUS

TOPIC: Obstructive Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Despite recent advances in the diagnosis and treatment of asthma, status asthmaticus continues to be associated with significant morbidity mortality. An estimated 60% patients admitted intensive care unit require intubation1. Ketamine, Magnesium, Heliox are some rescue therapies described literature for refractory asthmaticus2. Sevoflurane is an inhaled anesthetic that has been successfully used asthmaticus, however, its use largely limited case reports3. We present unique a 45-year-old male who received sevoflurane anticipation veno-venous extracorporeal membrane oxygenation (VV-ECMO) asthmaticus. CASE PRESENTATION: A past medical history severe persistent asthma was acute exacerbation. He denied any previous intubations reported active cigar smoking. Chest x-ray demonstrated hyperinflation. bronchodilators, high dose systemic steroids, non-invasive positive pressure ventilation, he intubated worsening hypercapnic respiratory failure. subsequently required including ketamine, epinephrine, magnesium, aminophylline. this, continued remain hypercarbic acidotic bronchospasm elevated peak pressures (PPrs) 100 mmhg optimization ventilator keep plateau under 30 mmhg. Serial arterial blood gases (ABGs) showed hypercarbia (PaCO2 >100 mmhg) acidosis (pH<7.1). PaO2 remained above 55mmhg. Cardiothoracic surgery consulted evaluation by means VV-ECMO. The patient transported OR given perioperatively prior cannulation. ABGs were obtained planned cannulation revealed improvement (PaCO2<70mmhg) (pH>7.3). deemed not candidate VV-ECMO returned ICU. exhibited marked over next few hours extubated 5 days later. DISCUSSION: potential bronchodilator properties sevoflurane, almost operating room, allowed dynamics deferral ECMO initiation. Physicians must consider inhalational volatile as therapy CONCLUSIONS: trial could reasonable growing body reports should prompt consideration formal study anesthetics exacerbations. Additionally, further research on how safely ICU setting where currently limited. REFERENCE #1: Peters JI, Stupka JE, Singh H, Rossrucker J, Angel LF, Melo Levine SM. Status unit: 30-year experience. Respir Med. 2012 Mar;106(3):344-8. doi: 10.1016/j.rmed.2011.11.015. Epub 2011 Dec 20. PMID: 22188845. #2: Ng D, Fahimi Hern HG. administration initiated out ED life-threatening Am J Emerg 2015 Aug;33(8):1110.e3-6. 10.1016/j.ajem.2015.01.005. Jan 16. 25662208. #3: Schutte Zwitserloot AM, Houmes R, de Hoog M, Draaisma JM, Lemson J. children. Br Anaesth. 2013 Dec;111(6):967-70. 10.1093/bja/aet257. Jul 24. 23884875. DISCLOSURES: No relevant relationships Ionut Albu, source=Web Response Benjamin Carmel, Mauricio Danckers, Davide Fox, Kishankumar Patel,