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Acute iterative bronchospasm and "do not re-intubate" orders: sedation by an alpha-2 agonist combined with noninvasive ventilation.

Abstract
A male patient presented with bronchospasm and acute respiratory distress. The patient had presented 2 previous episodes of severe bronchospasm following abdominal surgery, leading twice to intubation, mechanical ventilation, and conventional sedation. As the patient positively rejected a third episode of intubation + mechanical ventilation, noninvasive ventilation (pressure support = 8 cm H₂O, positive end-expiratory pressure = 10 cm H₂O), inhaled therapy, and clonidine orally (≈ 4 μg/kg) were combined. Over 1 to 2 hours, the acute respiratory distress disappeared. Noninvasive ventilation was discontinued on the next morning (day 2). The patient was discharged from the critical care unit on day 3 on good condition but died at a later interval from iterative bronchospasm. Evidence-based documentation of the effects of alpha-2 agonists in the setting of acute bronchospasm in the emergency department or status asthmaticus in the critical care unit is awaited.
AuthorsC Galland, B Sergent, C Pichot, M Ghignone, L Quintin
JournalThe American journal of emergency medicine (Am J Emerg Med) Vol. 33 Issue 6 Pg. 857.e3-5 (Jun 2015) ISSN: 1532-8171 [Electronic] United States
PMID25572642 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Adrenergic alpha-2 Receptor Agonists
  • Clonidine
Topics
  • Acute Disease
  • Adrenergic alpha-2 Receptor Agonists (administration & dosage, therapeutic use)
  • Bronchial Spasm (therapy)
  • Clonidine (administration & dosage, therapeutic use)
  • Fatal Outcome
  • Humans
  • Male
  • Noninvasive Ventilation
  • Recurrence
  • Retreatment

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