Life-saving Inhaled Sevoflurane Administered to an Adult With Severe Bronchospasm Secondary to COPD Exacerbation

Abstract

Chronic obstructive pulmonary disease (COPD) affects over 12 million US adults, with millions more going undiagnosed. With exceedingly high levels of morbidity and mortality, it is crucial to identify rescue therapies for COPD exacerbations that are refractory to conventional therapies. Conventional therapies include supplemental oxygen, bronchodilators (β-agonists and anticholinergics), systemic corticosteroids, macrolide antibiotics, and noninvasive positive-pressure ventilation. When conventional therapies fail, rescue and salvage therapies must be considered, such as invasive mechanical ventilation, magnesium sulfate, ketamine, inhaled helium-oxygen admixture (heliox), or inhaled anesthetics. Inhaled anesthetics have long been used in the pediatric population as salvage therapy for status asthmaticus; however, there is a lack of literature to support their use in adults with severe bronchospasm due to COPD exacerbation. We present the case of a 60-year-old man who was admitted with severe COPD exacerbation, with critical bronchospasm that required mechanical ventilation after failed conventional therapies. This patient received oxygen, inhaled β-agonists and anticholingerics, intravenous corticosteroids, and macrolide antibiotics. He then required mechanical ventilation with administration of magnesium, ketamine, and inhaled heliox for his bronchospasm, with no improvement. Ultimately, he was treated successfully with an inhaled anesthetic, sevoflurane, as salvage therapy. Success was measured by decreasing peak and plateau airway pressures and a decreasing partial pressure of carbon dioxide during the administration of sevoflurane. Our case suggests an important and potential life-saving application for sevoflurane in the setting of an adult with severe bronchospasm, and larger investigations should be established to assess its role as a mainstay in rescue therapy.