Sevoflurane-induction via the Flow-i ventilator in the pediatric intensive care unit for the treatment of status asthmaticus: a case report and literature review.

Abstract

Introduction: Status asthmaticus is a severe asthma exacerbation commonly associated with hypercarbia, hypoxia, and respiratory acidosis that can be unresponsive to conventional therapies. Non-invasive positive pressure ventilation is utilized as the first modality of respiratory support. Inhaled anesthetic agents are non-standard treatment options which can be considered for their bronchodilator properties once the patient is intubated.

Case report: We present a 14-year-old adolescent with a history of severe persistent asthma who was admitted to the pediatric intensive care unit (PICU) in status asthmaticus. The patient required intubation, was induced with sevoflurane, and mechanically ventilated with the Flow-i ventilator.

Discussion: Status asthmaticus is described as severe asthma that is refractory to repeated administration of beta-agonists, while near-fatal asthma is described as exacerbations requiring intubation and mechanical ventilation. When mechanical ventilation and conventional therapies are inadequate, inhalational anesthetics and extracorporeal membrane oxygenation (ECMO) are considered. This article examines the use of sevoflurane as a treatment modality for pediatric patients with status asthmaticus highlighting the therapeutic approach and outcome.

Conclusion: The use of inhaled anesthetic gases and advanced anesthesia machines can diversify and enhance treatment for patients with refractory status asthmaticus. With continuous monitoring of hemodynamics, anesthesia machines may be an integral therapeutic option for treating refractory status asthmaticus within the PICU without the need for extracorporeal life support.