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Description
Asthma is a chronic respiratory disease affecting nearly 10% of the population worldwide. Acute exacerbations can trigger status asthmaticus, a life-threatening condition characterized by persistent bronchospasm unresponsive to standard medications, including bronchodilators and corticosteroids. Standard management includes high-dose inhaled β-agonists, systemic corticosteroids, supplemental oxygen, intravenous magnesium sulfate, and mechanical ventilation if refractory. However, some cases require further intervention. Inhaled anesthetics, especially sevoflurane and isoflurane, represent additional treatment modalities that induce bronchodilation. Median treatment duration is 22.5 hours, with the majority of cases resolving within a few days and the longest reported case requiring 17 days. We report a case of refractory status asthmaticus treated with inhaled anesthetic for 10 days.
A 9-year-old female with poorly controlled asthma, atopic dermatitis, and allergic rhinitis presented with acute hypoxic respiratory failure due to status asthmaticus. On initial presentation, physical exam revealed significantly increased work of breathing, tachycardia, tachypnea, hypertension, and diminished breath sounds with a prolonged expiratory phase. The patient was afebrile with SpO₂ 100% on room air. Initial arterial blood gas showed pH 7.06, PaCO₂ 98 mmHg, and PaO₂ 117.3 mmHg on room air. Chest radiograph demonstrated bilateral central peribronchial thickening with a new patchy opacity in the right lower lobe. Respiratory viral panel was negative. The patient met criteria for severe status asthmaticus based on persistent bronchospasm despite maximal medical therapy and impending respiratory failure.
In patients with severe status asthmaticus refractory to initial management requiring intubation, inhaled anesthetics provide an effective alternative therapy. While median treatment duration with inhaled anesthetics is 22.5 hours, prolonged administration may be necessary for refractory cases. This patient required 10 days of inhaled anesthetic treatment, representing one of the longer reported durations of use for status asthmaticus. This case supports the safety and efficacy of extended inhaled anesthetic therapy in pediatric refractory status asthmaticus.
Publication Date
5-8-2026
Disciplines
Anesthesiology
Recommended Citation
Hamdan R, McKheen A, Huntington J. Prolonged inhaled anesthetic therapy for refractory status asthmaticus. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2150