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

Abstract

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.

COVID-19 and heme oxygenase: novel insight into the disease and potential therapies

“…(Brioni et al 2017;Schmidt 2004) Interestingly, long-term isoflurane helps recovery and reduces bronchospasm from herpes simplex pneumonia. (Hornuss et al 2010) Sevoflurane improved pulmonary mechanics and gas exchange in a case series of infants with severe bronchiolitis and acute respiratory distress syndrome. (Nacoti et al 2018) In short, a controlled clinical trial of isoflurane or sevoflurane when intubated COVID-19 patients are sedated is warranted.…”