title: 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.
authors.affiliation: Critical Care, Hôpital de St Omer, France.
authors.forename: C
authors.initials: C
authors.lastname: Galland
authors.affiliation: Critical Care, Hôpital de St Omer, France.
authors.forename: B
authors.initials: B
authors.lastname: Sergent
authors.affiliation: Physiology, University of Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Pichot
authors.affiliation: Columbia Hospital, W Palm Beach, FL.
authors.forename: M
authors.initials: M
authors.lastname: Ghignone
authors.affiliation: Physiology, University of Lyon, France. Electronic address: quintin@univ-lyon1.fr.
authors.forename: L
authors.initials: L
authors.lastname: Quintin
mesh_terms: D000208:Acute Disease; D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001986:Bronchial Spasm / Q000628:therapy*; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D063087:Noninvasive Ventilation; D012008:Recurrence; D019233:Retreatment
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D003000:Clonidine