Abstract
Inhaled Isoflurane is an accepted alternative to overcome severe status asthmaticus that fails to improve with maximal standard therapy. We used Isoflurane as a last resort treatment in five infants (without prior history of airway disease) who were mechanically ventilated for: respiratory failure induced by viral infections (2 patients aged 3 and 6 months), two other infants (ages 18 and 24 months) developed anaphylactic bronchospasm due to Ascasris related Loeffler syndrome, and one infant (aged 10 months) with severe airway disease due to gastroesophageal reflux. All patients received conventional bronchodilating therapy to no avail, progressing to mechanical ventilation. When respiratory support failed to normalize blood gases, Isoflurane was added. Clinical and blood gas improvement were notrd as early as 30 minutes postinhalation. Drops in airway resistance and improved dynamic compliances were noticed after the first hour of treatment. Because of severe lung disease, the infant with adenoviral disease required Isoflurane for 21 consecutive days, whereas all others were weaned successfully after 4 to 5 days. No adverse effects were noticed despite prolonged treatment. Isoflurane may be considered a useful alternative for non asthmatic bronchospasm for individual patients when conventional treatment fails and mechanical ventilation must be started.
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