The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

A REVIEW OF ISOFLURANE USE IN A PEDIATRIC ICU

David Heitz RRT-NPS, Patricia Donald RRT, Julianne Socha RRT,

Peter Betit RRT-NPS, David A.Turner MD.

Children's Hospital Boston and Harvard Medical School , Boston , MA

Introduction: Isoflurane (Forane®) is an anesthetic agent with bronchodilator properties. Isoflurane (ISO) is used in our PICU as an adjunct in the treatment of severe bronchospasm refractory to conventional therapies. We use a modified Servo 900C ventilator (Maquet Inc, Bridgewater , NJ ) fitted with an ISO vaporizer and scavenging system. We report our experience over a six year period from 01/99 - 03/06.

Methods:
The medical records of patients treated with ISO were reviewed.  We evaluated demographics, blood gas data, ISO doses, and duration of ISO therapy. PaCO2 measurements prior ISO were compared with subsequent values obtained at 1, 4, and 8 hours. A positive response was defined as a decrease in PaCO2 ³ 5 mmHg. The Wilcoxon Signed Ranks Test was used to evaluate statistical significance.

  PaCO2 (mmHg)
Patient Pre-tx 1 Hr 4 Hr 8 Hr
1 95 77 67 44
2 121 71 55 37
3 63 57 59 61
4 187 85 44 39
5 68 68 69 56
6 83 76 62 61
7 60 60 52 54
8 72 47 46 60
9 121 49 47 53
10 95 105 92 70
11 67 77 66 51
12 155 PvCO2 115 75 70
13 160 109 72 57
14 58 63 53 51
15 133 105 53 51
16 56 46 42  

Results:  Sixteen patients, age 5 mos-24 yrs, received ISO; 12 status asthmaticus, 2 reactive airway disease, 1 bronchiolitis, and 1 chronic lung disease. The average initial ISO dose was 0.5%, range 0.2-1%. The average ISO duration was 58 hours, range 7-240 hours. The average maximum ISO dose was 1%, range 0.3-2.1%. There was a statistically significant decrease in PaCO2 at 1 hour (p=0.009), 4 hours (p=0.001), and 8 hours (p=0.001) (see table). A positive response was seen in 11/16 patients. Five patients had delayed responses; 2 at hour 4, and 3 at hour 8. Overall, l5/16 patients demonstrated sustained improvement with ISO. There was also statistically significant evidence of continued improvement during ISO when comparing PaCO2 between 1 and 4 hours (p = 0.001), and 1 and 8 hours (p=0.004).  All patients were successfully weaned from ISO, and all but one survived to discharge.

Conclusion:  From our experience, the vast majority of patients treated with ISO had an immediate and sustained response as defined by improvement in CO2 elimination. The patients who did not initially respond eventually demonstrated improvement within 8 hours of starting therapy.  ISO appears to be an effective adjunct therapy in the treatment of respiratory failure due to severe and potentially life threatening bronchospasm.


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