Abstract
A 47-year-old man with a history of heart transplant was admitted after severe traumatic brain injury and seizures. During mechanical ventilation, the patient developed bronchospasm that severely compromised respiratory function that led to cardiac arrest. After resuscitation, application of isoflurane through the Anaesthetic Conserving Device (AnaConDa) in the ICU successfully treated bronchospasm, provided adequate sedation, and enabled appropriate ventilation and diagnostic bronchoscopy. A subsequent bronchoalveolar lavage revealed a high amount of Herpes simplex DNA. Herpes simplex pneumonia was diagnosed and treated with acyclovir. Isoflurane treatment was applied for twelve days total without side effects on renal and cerebral function. The patient recovered quickly after the termination of sedation. At discharge, he was fully awake without focal neurological deficiency and his long-term outcome was excellent. This case demonstrates that isoflurane is a treatment option in life-threatening cases of bronchospasm and a safe option for long-term sedation.
Highlights
The volatile anesthetic drug isoflurane reduces respiratory resistance and can be applied to treat severe bronchospasm [1, 2]
Bronchospasm was most likely caused by HSV-1 pneumonia
High concentrations of HSV-1 DNA was detected in bronchoalveolar lavage (BAL), but no other sign of bacterial or fungal infection was found after microbiological cultures and DNA analyses
Summary
The volatile anesthetic drug isoflurane reduces respiratory resistance and can be applied to treat severe bronchospasm [1, 2]. Though isoflurane is typically administered only for a short period for general anesthesia, it may be a viable treatment option for severe bronchospasm and for sedation during critical care. Little experience has been had with long-term treatment of isoflurane (>1 week) or use in patients with traumatic brain injury due to concerns regarding renal toxicity and increased intracranial pressure. This case report illustrates the successful long-term application of isoflurane in a critically ill patient with several underlying comorbidities
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