title: Isoflurane for life-threatening bronchospasm: a 15-year single-center experience.
abstract: BACKGROUND
  Children with severe bronchospasm requiring mechanical ventilation may become refractory to conventional therapy. In these critically ill patients, isoflurane is an inhaled anesthetic agent available in some centers to treat bronchospasm. We hypothesized that isoflurane  is safe and would lead to improved gas exchange in children with life-threatening bronchospasm refractory to conventional therapy.
  
  
  METHODS
  A retrospective review was conducted and included mechanically ventilated children treated with isoflurane in a quaternary pediatric ICU for life-threatening  bronchospasm, from 1993 to 2007. Demographic, blood gas, ventilator, and outcome data were collected.
  
  
  RESULTS
  Thirty-one patients, with a mean age of 9.5 years (range 0.4-23 years) were treated with isoflurane, from 1993 to 2007. Mean time to initiation of isoflurane after intubation  was 13 hours (0-120 h), and the mean maximum isoflurane dose was 1.1% (0.3-2.5%). Mean duration of isoflurane administration was 54.5 hours (range 1-181 h), with a total mean duration of mechanical ventilation of 252 hours (range 16-1,444 h). Isoflurane led to significant  improvement in pH and P(CO(2)) within 4 hours of initiation (P ≤ .001). Complications during isoflurane administration included hypotension requiring vasoactive infusions in 24 (77%), arrhythmia in 3 (10%), neurologic side effects in 3 (10%), and pneumothorax in  1 (3%) patient.
  
  
  CONCLUSIONS
  Isoflurane led to improvement in pH and P(CO(2)) within 4 hours in this series of mechanically ventilated patients with life-threatening bronchospasm. The majority of patients in this series developed hypotension, but there was a low incidence  of other side effects related to isoflurane administration. Isoflurane appears to be an effective therapy in patients with life-threatening bronchospasm refractory to conventional therapy. However, further investigation is warranted, given the uncertain overall impact of isoflurane in this  context.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC 27710, USA. david.turner@duke.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.forename: David
authors.initials: D
authors.lastname: Heitz
authors.forename: Mehrengise K
authors.initials: MK
authors.lastname: Cooper
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.forename: John H
authors.initials: JH
authors.lastname: Arnold
authors.forename: Scot T
authors.initials: ST
authors.lastname: Bateman
mesh_terms: D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D001986:Bronchial Spasm / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007530:Isoflurane / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D007530:Isoflurane