Inhalational Anesthetics in Acute Severe Asthma

Vaschetto, Rosanna; Bellotti, Enrico; Turucz, Emilia; Gregoretti, Cesare; Corte, Francesco Della; Navalesi, Paolo

doi:10.2174/138945009789108747

Cited by 26 publications

(16 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been suggested that halogenated gas ensures adequate ventilation by decreasing airway resistance [25]. While the one patient who was treated with halogenated gas in our study had a good outcome, the evidence for the efficacy of this technique is based only on small case reports [26]. Indications for this treatment, which is not included in recent recommendation [10], have yet to be clearly defined.…”

Section: Discussionmentioning

confidence: 78%

See 1 more Smart Citation

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

et al. 2020

View full text Add to dashboard Cite

Patients with acute severe asthma (ASA) may in rare cases require invasive mechanical ventilation (IMV). However, recent data on this issue are lacking. Materials and methods In this retrospective and bicentric study conducted on a 10 year period, we investigate the in-hospital mortality in patients with ASA requiring IMV. We compare this mortality to that of patients with other types of respiratory distress using a standardized mortality ratio (SMR) model. Results Eighty-one episodes of ASA requiring IMV were evaluated. Factors significantly associated with in-hospital mortality were cardiac arrest on day of admission, cardiac arrest as the reason for intubation, absence of decompensation risk factors, need for renal replacement therapy on day of admission, and intubation in pre-hospital setting. Non-survivors had higher SAPS II, SOFA, creatinine and lactate levels as well as lower blood pressure, pH, and HCO 3 on day of admission. In-hospital mortality was 15% (n = 12). Compared to a reference population of 2,670 patients, the SMR relative to the SAPS II was very low at 0.48 (95% CI, 0.25-0.84). The only factor independently associated with in-hospital mortality was cardiac arrest on day of admission. In-hospital mortality was 69% in patients with cardiac arrest on day of admission and 4% in others (p < 0.01). Salvage therapies were given to 7 patients, sometimes in combination with each other: ECMO (n = 6), halogenated gas (n = 1) and anti-IL5 antibody (n = 1). Death occurred in only 2 of these 7 patients, both of whom had cardiac arrest on day of admission.

show abstract

Section: Discussionmentioning

confidence: 78%

“…All patients were known to have asthma. Atopy was found in 87% of the patients, and the diagnosis of asthma was made 21 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] years earlier. A quarter of the patients had a previous episode of ASA that required IMV.…”

Section: Resultsmentioning

confidence: 99%

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Though volatile anesthetics have been shown to be effective in acute asthmatic bronchospasm, data on prolonged application is rare [11]. A common concern against the prolonged use of volatile anesthetics is their potential harm to renal function.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Isoflurane Therapy for Refractory Bronchospasm Associated with Herpes Simplex Pneumonia in a Heart Transplant Patient

Hornuß

Firsching

Dolch

et al. 2010

Case Reports in Medicine

View full text Add to dashboard Cite

A 47-year-old man with a history of heart transplant was admitted after severe traumatic brain injury and seizures. During mechanical ventilation, the patient developed bronchospasm that severely compromised respiratory function that led to cardiac arrest. After resuscitation, application of isoflurane through the Anaesthetic Conserving Device (AnaConDa) in the ICU successfully treated bronchospasm, provided adequate sedation, and enabled appropriate ventilation and diagnostic bronchoscopy. A subsequent bronchoalveolar lavage revealed a high amount of Herpes simplex DNA. Herpes simplex pneumonia was diagnosed and treated with acyclovir. Isoflurane treatment was applied for twelve days total without side effects on renal and cerebral function. The patient recovered quickly after the termination of sedation. At discharge, he was fully awake without focal neurological deficiency and his long-term outcome was excellent. This case demonstrates that isoflurane is a treatment option in life-threatening cases of bronchospasm and a safe option for long-term sedation.

show abstract

“…All of the available VAs, halothane, isoflurane, sevoflurane, and desflurane, have been used to treat refractory SA . However, given that desflurane has been shown to increase airway resistance in children with high airway susceptibility , caution should be taken when considering its use in the pediatric patient with SA.…”

Section: Treatmentmentioning

confidence: 99%

Volatile anesthetics for status asthmaticus in pediatric patients: a comprehensive review and case series

Carrié

Anderson

2015

Pediatric Anesthesia

View full text Add to dashboard Cite

Status asthmaticus is an acute, intractable asthma attack refractory to standard interventions that can lead to progressive respiratory failure. Successful management requires a fundamental understanding of the disease process, its clinical presentation, and proper evaluation. Treatment must be instituted early and is aimed at reversing the airway inflammation, bronchoconstriction, and hyper-reactivity that often lead to lower airway obstruction, impaired ventilation, and oxygenation. Most patients are effectively treated with standard therapy including beta2-adrenergic agonists and corticosteroids. Others necessitate adjunctive therapies and escalation to noninvasive ventilation or intubation. We will review the pathophysiology, evaluation, and treatment options for pediatric patients presenting with status asthmaticus with a particular focus on refractory status asthmaticus treated with volatile anesthetics. In addition, we include a proven approach to the management of these patients in the critical care setting, which requires close coordination between critical care and anesthesia providers. We present a case series of three patients, two of which have the longest reported cases of continuous isoflurane use in status asthmaticus. This series was obtained from a retrospective chart review and highlights the efficacy of the volatile anesthetic, isoflurane, in three pediatric patients with refractory life-threatening status asthmaticus.

show abstract

Inhalational Anesthetics in Acute Severe Asthma

Cited by 26 publications

References 0 publications

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study

Long-Term Isoflurane Therapy for Refractory Bronchospasm Associated with Herpes Simplex Pneumonia in a Heart Transplant Patient

Volatile anesthetics for status asthmaticus in pediatric patients: a comprehensive review and case series

Contact Info

Product

Resources

About