Chest
Clinical Investigations in Critical CareIsoflurane Therapy for Status Asthmaticus in Children and Adults
Section snippets
CASE 1
A 20-year-old woman with a seven-year history of asthma was admitted to the hospital with a history of worsening bronchospasm for one week following a flu-like illness. She had been using albuterol, ipratropium, and beclomethasone inhalers without improvement. She was transferred to our Intensive Care Unit (ICU) owing to increasing respiratory distress. On admission to the ICU, her heart rate (HR) was 120 beats per minute, respiratory rate (RR) was 18 breaths per minute, and blood pressure (BP)
DISCUSSION
Isoflurane produces bronchodilation through β-adrenergic receptor stimulation, direct relaxation of bronchial smooth muscle, antagonism of the action of acetylcholine and histamine, and interference with hypocapnic bronchoconstriction.6 Thus, a patient who is already receiving maximum doses of standard bronchodilators may show an additional response. As our case reports suggest, isoflurane acts rapidly and may be lifesaving while high-dose corticosteroids take effect. In contrast, ketamine, an
ACKNOWLEDGMENTS
We wish to thank Sylvia Goruk for assistance in preparing this manuscript.
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Manuscript received November 7, 1988; revision accepted August 18.