Outcomes of children with life-threatening status asthmaticus requiring isoflurane therapy and extracorporeal life support

Abstract

Background

Severe, refractory asthma is a life-threatening emergency that may be treated with isoflurane and extracorporeal life support. The objective of this study was to describe the clinical response to isoflurane and outcomes after discharge of children who received isoflurane and/or extracorporeal life-support for near-fatal asthma.

Methods

This was a retrospective descriptive study using electronic medical record data from two pediatric intensive care units within a single healthcare system in Atlanta, GA.

Results

Forty-five children received isoflurane, and 14 children received extracorporeal life support, 9 without a trial of isoflurane. Hypercarbia and acidosis improved within four hours of starting isoflurane. Four children died during the index admission for asthma. Twenty-seven percent had a change in Functional Status Score of three or more points from baseline to PICU discharge. Patients had median percent predicted FEV1 and FEV1/FVC ratios pre- and post-bronchodilator values below normal pediatric values.

Conclusion

Children who received isoflurane and/or ECLS had a high frequency of previous PICU admission and intubation. Improvement in ventilation and acidosis occurred within the first four hours of starting isoflurane. Children who required isoflurane or ECLS may develop long-lasting deficits in their functional status. Children with near-fatal asthma are a high-risk group and require improved follow-up in the year following PICU discharge.

Keywords:

• Isoflurane
• extracorporeal life-support
• status asthmaticus
• pediatric intensive care unit
• functional status score
• pulmonary function tests

Acknowledgements

We acknowledge the Emory + Children’s Pediatric Research Biostatistics Core for help with statistical analysis.

Authors’ contributions

JG and AF conceived and developed the study, supervised the acquisition of the data, analyzed and interpreted the data. JG, AW, and SG performed and interpreted the statistical analyses. JG and SK drafted and edited the manuscript. PK and AF assisted with editing the manuscript. SK, CO, BT, and CM assisted in collecting clinical information about the patients. All authors edited and approved the final version of this manuscript.

Declaration of interest

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

Additional information

Funding

This study was supported in part by K24 NR018866 awarded to AF; K23HL151897 awarded to JG; Children’s Healthcare of Atlanta Pediatric Research Alliance Warshaw Fellowship Research Award to SK. National Heart, Lung, and Blood Institute;National Institute of Nursing Research.