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Abstract
Asthma is the most common chronic disease of childhood. Despite a better understanding of the disease process and its management, status asthmaticus continues to be a life-threatening event. The use of volatile inhaled anesthetics is infrequently reported as adjunctive therapy to conventional treatment of this condition. We report the use of halothane in a mechanically ventilated pediatric patient with life-threatening status asthmaticus who was admitted to the pediatric intensive care unit (PICU) after failing to respond to standard medical therapy and noninvasive positive pressure ventilation. A 12-year-old African American male was seen in the emergency department and treated with intravenous corticosteroids, beta-agonist therapy. He deteriorated rapidly and required endotracheal intubation and mechanical ventilation. Two hours later, the patient developed an acute, severe respiratory acidosis (pH = 6.97, PaCO2 = 171, PaO2 = 162, BE = 1.7). Halothane was started at 2% by using the Siemens Servo 900C anesthesia ventilator. Improvement in both arterial blood gases and exhaled tidal volume were noted 30 minutes after initiation of the anesthetic gas. The patient remained on halothane for a total of 36 hours. No adverse effects associated with the use of halothane were noted. The patient was extubated to BiPAP 16/6, FiO2 = 0.30 at 68 hours and was discharged home 5 days later.
| Abbreviations | ||
| MAC: | = | minimal alveolar concentration |
| CXR: | = | chest x ray |
| ABG: | = | arterial blood gas |
| PaCO2: | = | partial pressure of arterial carbon dioxide |
| PaO2: | = | partial pressure of arterial oxygen |
| FiO2: | = | fraction of inspired oxygen |
| BiPAP: | = | bilevel positive airway pressure |
| ETT: | = | endotracheal tube |
| PCV: | = | pressure control ventilation |
| PIP: | = | peak inspiratory pressure |
| PEEP: | = | positive end expiratory pressure |
| ETCO2: | = | end-tidal carbon dioxide |