Sevoflurane therapy for severe refractory bronchospasm in children.
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2016
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Lippincott, Williams & Wilkins
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Palacios A, Mencía S, Llorente AM, Cruz J, Toledo B, Ordóñez O, Olmedilla M, Lopez-Herce J. Sevoflurane Therapy for Severe Refractory Bronchospasm in Children. Pediatr Crit Care Med. 2016 Aug;17(8):e380-4. doi: 10.1097/PCC.0000000000000852. PMID: 27362849.
Abstract
Este artículo presenta una serie de casos clínicos que exploran el uso del sevoflurano en el tratamiento del broncoespasmo severo en niños. Aunque se trata de un estudio con limitaciones propias de este tipo de diseño, los resultados sugieren que el sevoflurano puede ser una opción terapéutica eficaz en casos refractarios. La publicación del artículo en una revista de alto impacto y su posterior citación por parte de otros investigadores demuestran su relevancia científica.
Objectives: To describe the effect of inhaled sevoflurane in the treatment of severe refractory bronchospasm in children. Design: Retrospective case series. Setting: Two PICUs of tertiary general university hospitals in Spain. Patients: Ten patients ranging from 5 months to 14 years old with severe bronchospasm and acute respiratory failure requiring tracheal intubation and mechanical ventilation and treated with sevoflurane from 2008 to 2015. Intervention: Inhaled sevoflurane therapy was initiated after failure of conventional medical management and mechanical ventilation. In two patients, sevoflurane was administered through a Servo 900C ventilator (Maquet, Bridgewater, NJ) equipped with a vaporizer and in the other eight patients via the Anesthetic Conserving Device (AnaConDa; Sedana medical, Uppsala, Sweden) with a critical care ventilator. Measurements and Main Results: Inhaled sevoflurane resulted in statistically significant decreases of Paco2 of 34.2 torr (95% CI, 8.3–60), peak inspiratory pressure of 14.3 cm H2O (95% CI, 8.6–19.9), and improvement in pH of 0.17 (0.346–0.002) within 6 hours of administration. Only one patient presented hypotension responsive to volume administration at the beginning of the treatment. All patients could be extubated within a median time of 120 hours (interquartile range, 46–216). Conclusions: Inhaled sevoflurane therapy decreases the levels of Paco2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.
Objectives: To describe the effect of inhaled sevoflurane in the treatment of severe refractory bronchospasm in children. Design: Retrospective case series. Setting: Two PICUs of tertiary general university hospitals in Spain. Patients: Ten patients ranging from 5 months to 14 years old with severe bronchospasm and acute respiratory failure requiring tracheal intubation and mechanical ventilation and treated with sevoflurane from 2008 to 2015. Intervention: Inhaled sevoflurane therapy was initiated after failure of conventional medical management and mechanical ventilation. In two patients, sevoflurane was administered through a Servo 900C ventilator (Maquet, Bridgewater, NJ) equipped with a vaporizer and in the other eight patients via the Anesthetic Conserving Device (AnaConDa; Sedana medical, Uppsala, Sweden) with a critical care ventilator. Measurements and Main Results: Inhaled sevoflurane resulted in statistically significant decreases of Paco2 of 34.2 torr (95% CI, 8.3–60), peak inspiratory pressure of 14.3 cm H2O (95% CI, 8.6–19.9), and improvement in pH of 0.17 (0.346–0.002) within 6 hours of administration. Only one patient presented hypotension responsive to volume administration at the beginning of the treatment. All patients could be extubated within a median time of 120 hours (interquartile range, 46–216). Conclusions: Inhaled sevoflurane therapy decreases the levels of Paco2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.