Isoflurane therapy for status asthmaticus in children: A case series and protocol.

OBJECTIVE: To describe the use of inhaled isoflurane by using a standardized protocol in the treatment of respiratory failure secondary to status asthmaticus in a series of pediatric patients. DESIGN: Case series. SETTING: Pediatric intensive care unit of a tertiary care military medical facility. PATIENTS: Six pediatric patients ranging in age from 14 months to 15 yrs who were treated with isoflurane in our pediatric intensive care unit for status asthmaticus from 1995 to 1998. INTERVENTION: Inhaled isoflurane therapy was initiated by using the treatment protocol after the patients had failed conventional medical management in the treatment of their asthma. MEASUREMENTS AND MAIN RESULTS: All patients tolerated isoflurane therapy well by using our standardized protocol in conjunction with careful hemodynamic monitoring and support. The administration of inhaled isoflurane resulted in measurable improvements in the subject patients, as evidenced by statistically significant decreases in Paco2 and peak inspiratory pressures, as well as a significant increase in pH. All six patients were successfully extubated and were discharged from the hospital without apparent sequelae. CONCLUSIONS: We conclude isoflurane may be a safe, effective treatment modality in the management of status asthmaticus refractory to aggressive medical therapy, although further study is warranted. We emphasize this mode of therapy should be instituted only after traditional treatment modalities have failed and appropriate intensive care support is available.

Transient myocardial dysfunction in a child with salicylate toxicity.

Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in children. In addition to these more typical features, the 13-month-old boy reported here developed clinical, radiographic, and echocardiographic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shortening fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up echocardiography as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salicylate-induced pulmonary edema.