2000 OPEN FORUM Abstracts
USE OF HALOTHANE IN A PEDIATRIC PATIENT WITH STATUS ASTHMATICUS: A CASE REPORT
R. D Restrepo, MD, RRT, Georgia State University (GSU) and Children's Health Care of Atlanta at Egleston (CHOA), A. Ari, MS, CRT, CPFT (GSU), Patrick De Meuse, RRT, J. Fortenberry, MD. (CHOA). Atlanta, GA
BACKGROUND: Asthma is the most common chronic disease of childhood with prevalence in the US of 3% to 5%. Acute asthma attacks account for an estimated 1 to 2 million emergency department visits each year in the US. Despite our better understanding of the disease process and management, status asthmaticus continues to be a life-threatening event. The use of volatile inhaled anesthetics has been reported as adjunctive therapy to conventional treatment of this condition. We report the use of Halothane in one of our pediatric ventilated patients admitted with status asthmaticus.
PATIENT: This patient was a 12 year-old black male admitted to our PICU after failing to respond to conventional aerosol therapy in the ER. In the PICU, the patient was placed on BiPAP and managed with continuous aerosol therapy, and I.V corticosteroids but quickly deteriorated and required endotracheal intubation and mechanical ventilation. The ABG prior to intubation was: pH=7.27, PaCO2= 55, PaO2= 99, BE= -1.5, FiO2=100% via NRB mask. Following mechanical ventilation (PCV rate=20, PIP=40, PEEP= 6, Ti=1.0s, FiO2=1.0) the ABG revealed a pH= 7.57, PaCO2= 22, PaO2= 201, BE= 1.1. 24 hours later, the patient developed severe respiratory acidosis (pH= 6.97, PaCO2= 171, PaO2= 162, BE= 1.7). Halothane was immediately started at 2% in conjunction with mechanical ventilation using the Siemens Servo 900C anesthesia ventilator. Improvement in both arterial blood gases and exhaled tidal volume were noted thirty minutes after initiation of the anesthetic gas. The patient remained on Halothane for a total of 36 hours with concentrations averaging 0.75%. The patient was extubated 68 hours later to BiPAP 16/6, FiO2= .30.
|Prior to Intubation||7.27||55||99||-1.5||96%||1.0|
|Prior to Halothane||6.97||171||162||1.7||97%||1.0|
|Halothane 2% (30min)||7.23||73||124||1.5||97%||0.4|
|Halothane .5% (36h)||7.43||39||78||2.1||95%||0.4|
DISCUSSION: The use of Halothane in the management of this patient with status asthmaticus resulted in a rapid improvement of arterial blood gases without any adverse effect. With appropriate monitoring, Halothane may be a valuable therapeutic modality for the patients with status asthmaticus.