Alba Palacios1, Santiago Mencía, Ana M Llorente, Jaime Cruz, Blanca Toledo, Olga Ordóñez, Marta Olmedilla, Jesus Lopez-Herce. 1. 1Pediatric Intensive Care Unit, Department of Pediatrics, 12 de Octubre University Hospital, Madrid, Spain. 2Pediatric Intensive Care Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain. 3Department of Pediatrics, Medicine School, Complutense University of Madrid, Madrid, Spain. 4Mother-Child Health and Development Network (Red SAMID) of Carlos III Health Institute, RETICS funded by the PN I+D+I 2008-2011, Madrid, Spain. 5ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF) ref RD12/0026, Madrid, Spain. 6Pediatric Endocrinology Unit, Department of Pediatrics, 12 de Octubre University Hospital, Madrid, Spain.
Abstract
OBJECTIVES: To describe the effect of inhaled sevoflurane in the treatment of severe refractory bronchospasm in children. DESIGN: Retrospective case series. SETTING: Two PICUs of tertiary general university hospitals in Spain. PATIENTS: Ten patients ranging from 5 months to 14 years old with severe bronchospasm and acute respiratory failure requiring tracheal intubation and mechanical ventilation and treated with sevoflurane from 2008 to 2015. INTERVENTION: Inhaled sevoflurane therapy was initiated after failure of conventional medical management and mechanical ventilation. In two patients, sevoflurane was administered through a Servo 900C ventilator (Maquet, Bridgewater, NJ) equipped with a vaporizer and in the other eight patients via the Anesthetic Conserving Device (AnaConDa; Sedana medical, Uppsala, Sweden) with a critical care ventilator. MEASUREMENTS AND MAIN RESULTS: Inhaled sevoflurane resulted in statistically significant decreases of PaCO2 of 34.2 torr (95% CI, 8.3-60), peak inspiratory pressure of 14.3 cm H2O (95% CI, 8.6-19.9), and improvement in pH of 0.17 (0.346-0.002) within 6 hours of administration. Only one patient presented hypotension responsive to volume administration at the beginning of the treatment. All patients could be extubated within a median time of 120 hours (interquartile range, 46-216). CONCLUSIONS: Inhaled sevoflurane therapy decreases the levels of PaCO2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.
OBJECTIVES: To describe the effect of inhaled sevoflurane in the treatment of severe refractory bronchospasm in children. DESIGN: Retrospective case series. SETTING: Two PICUs of tertiary general university hospitals in Spain. PATIENTS: Ten patients ranging from 5 months to 14 years old with severe bronchospasm and acute respiratory failure requiring tracheal intubation and mechanical ventilation and treated with sevoflurane from 2008 to 2015. INTERVENTION: Inhaled sevoflurane therapy was initiated after failure of conventional medical management and mechanical ventilation. In two patients, sevoflurane was administered through a Servo 900C ventilator (Maquet, Bridgewater, NJ) equipped with a vaporizer and in the other eight patients via the Anesthetic Conserving Device (AnaConDa; Sedana medical, Uppsala, Sweden) with a critical care ventilator. MEASUREMENTS AND MAIN RESULTS: Inhaled sevoflurane resulted in statistically significant decreases of PaCO2 of 34.2 torr (95% CI, 8.3-60), peak inspiratory pressure of 14.3 cm H2O (95% CI, 8.6-19.9), and improvement in pH of 0.17 (0.346-0.002) within 6 hours of administration. Only one patient presented hypotension responsive to volume administration at the beginning of the treatment. All patients could be extubated within a median time of 120 hours (interquartile range, 46-216). CONCLUSIONS: Inhaled sevoflurane therapy decreases the levels of PaCO2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.