KETAMINE INFUSION FOR REFRACTORY STATUS ASTHMATICUS: A CASE SERIES

TOPIC: Allergy and Airway TYPE: Medical Student/Resident Case Reports INTRODUCTION: Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist that promotes bronchodilation through several mechanisms: blocking NDMA receptors to prevent bronchoconstriction, decreasing nitric oxide production in pulmonary tissues reduce bronchospasm, reducing inflammation reverse histamine-induced bronchoconstriction. These properties suggest intravenous (IV) ketamine has role the management of status asthmaticus, particularly refractory cases, but data remains limited. CASE PRESENTATION: Six patients (age 56 ±16 years, 33.3% female) receiving IV for asthmaticus at single center were identified retrospective chart review. All six received nebulized bronchodilators, steroids, magnesium prior therapy, required intubation. They treated with bolus infusion (ranging 0.5-2 mg/kg/hr). Pre post treatment pH CO2 improved overall (pH range 6.89-7.23 mean 7.05 improving 7.11-7.35, 7.21; pCO2 ranging 72-130 mm Hg 98 30-78 Hg, 58). Two had recrudescence symptoms decreased tidal volumes (500 280 mL one case, 580 420 second case) increased peak pressures after stopping without weaning. re-initiation gradual weaning further recurrence. other underwent recrudescence. DISCUSSION: In this center, case series, was shown demonstrate improvement pH, pCO2. Only patient significant tachycardia hypertension which midazolam. Slow infusions seemed recurrence four infusion, although two did not have abrupt discontinuation. CONCLUSIONS: cases should be considered as an adjunctive therapy. Additional studies are needed determine ideal rates regimen before REFERENCE #1: Goyal S, Agrawal A. Status Asthmaticus: A Review. Indian J Crit Care Med. 2013;17(3):154-161. #2: Howton JC, Rose J, Duffy Zoltanski T, Levitt MA. Randomized, Double-blind, Placebo-controlled Trial Intravenous Acute Asthma. Ann Emerg 1996;27(2):170-175. #3: Shlamovitz GZ, Hawthorne T. Dissociating Dose Temporizing Measure Avoid Mechanical Ventilation Adult Patient Severe Asthma Exacerbation. 2011;41(5):492-494. DISCLOSURES: No relevant relationships by Hangyul Chung-Esaki, source=Web Response Chris Lai Hipp, Gay Antonette Subia, Wendy Tawata, Miki Ueoka,