Isoflurane rescue therapy for bronchospasm reduces intracranial pressure in a patient with traumatic brain injury

Abstract

Primary objective: To assess the unusual use of a volatile anaesthetic for treatment of life-threatening bronchospasm in a patient with traumatic brain injury (TBI).

Research design: Case report.

Methods and procedures: This study presents a previously healthy 30-year-old man with severe TBI and bronchospasm-induced acute hypercapnia. He was treated with inhaled isoflurane in combination with monitoring of intracranial pressure (ICP) and regional cerebral blood flow (rCBF).

Results: Three-day-long isoflurane treatment resolved drug-refractory bronchospasm, decreased airway pressure and improved gas exchange, even at a low end-tidal concentration (0.3–0.5 vol%). Although rCBF was increased by 18 ml min^–1 100 g^–1 during isoflurane treatment, there was a significant decrease in ICP (21 (SD = 3) mmHg, 9 (SD = 5) mmHg, 2 (SD = 3) mmHg; during pre-treatment, treatment and post-treatment, respectively; p < 0.001). Improved autoregulation due to lower partial pressure of carbon dioxide, restoration of carbon dioxide reactivity, isoflurane-induced regional differences in rCBF and improved microcirculation may have been responsible for the prompt and long-lasting normalization of ICP. The patient had no TBI-related disability at 6 months post-injury.

Conclusions: Isoflurane at a low dose can be an effective and safe treatment option for drug-refractory bronchospasm in a patient with traumatic intracranial hypertension, provided that multimodality neuromonitoring is used.

Keywords:

• Cerebral blood flow (CBF)
• head injury
• volatile anaesthetic
• hypercapnia
• mechanical ventilation
• multimodality neuromonitoring

Acknowledgements

We express our gratitude to Dr. Bojan Lazar (University of Primorska) for constructive comments on an early draft of the manuscript. We thank Dr. Marjan Korsic (University Medical Centre Ljubljana) for placement of the rCBF probe and Dr. Tomislav Mirkovic (University Medical Centre Ljubljana) for NCCU co-management of the patient.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.