Status asthmaticus is an acute, intractable
asthma attack refractory to standard interventions that can lead to progressive
respiratory failure. Successful management requires a fundamental understanding of the disease process, its clinical presentation, and proper evaluation. Treatment must be instituted early and is aimed at reversing the airway
inflammation, bronchoconstriction, and hyper-reactivity that often lead to lower
airway obstruction, impaired ventilation, and oxygenation. Most patients are effectively treated with standard
therapy including beta2-adrenergic agonists and
corticosteroids. Others necessitate adjunctive
therapies and escalation to
noninvasive ventilation or intubation. We will review the pathophysiology, evaluation, and treatment options for pediatric patients presenting with
status asthmaticus with a particular focus on refractory
status asthmaticus treated with volatile
anesthetics. In addition, we include a proven approach to the management of these patients in the
critical care setting, which requires close coordination between
critical care and
anesthesia providers. We present a case series of three patients, two of which have the longest reported cases of continuous
isoflurane use in
status asthmaticus. This series was obtained from a retrospective chart review and highlights the efficacy of the volatile
anesthetic,
isoflurane, in three pediatric patients with refractory life-threatening
status asthmaticus.