Asthma is the most common
chronic disease of childhood. Despite a better understanding of the disease process and its management,
status asthmaticus continues to be a life-threatening event. The use of volatile inhaled
anesthetics is infrequently reported as adjunctive
therapy to conventional treatment of this condition. We report the use of
halothane in a mechanically ventilated pediatric patient with life-threatening
status asthmaticus who was admitted to the pediatric intensive care unit (PICU) after failing to respond to standard medical
therapy and noninvasive
positive pressure ventilation. A 12-year-old African American male was seen in the emergency department and treated with intravenous
corticosteroids, beta-agonist
therapy. He deteriorated rapidly and required endotracheal intubation and
mechanical ventilation. Two hours later, the patient developed an acute, severe
respiratory acidosis (pH=6.97, PaCO2=171, PaO2=162, BE=1.7).
Halothane was started at 2% by using the Siemens Servo 900C
anesthesia ventilator. Improvement in both arterial blood
gases and exhaled tidal volume were noted 30 minutes after initiation of the
anesthetic gas. The patient remained on
halothane for a total of 36 hours. No adverse effects associated with the use of
halothane were noted. The patient was extubated to BiPAP 16/6, FiO2=0.30 at 68 hours and was discharged home 5 days later.