Q: Name few treatment modalities in Status Asthmaticus if all conventional treatments including mechanical ventilation fails?
Answer:
Ketamine: has been shown to improve airway resistance, particularly the lower airways, as well as improve lung compliance. Dose: loading dose of 1 mg/kg (IV), followed by a continuous infusion of 1 mg/kg/hr for 2h. Peak airway pressure, PaCO2 and PaO2 should be monitored.
Deep anesthesia: such as with halothane or enflurane in combination with propofol or ketamine, may also be effective treatment as potent bronchodilators.
Nitric oxide: has also been used in isolated case reports.
Nebulized lidocaine: in combination with albuterol or levalbuterol is effective in helping the vocal cord dysfunction that may accompany status asthmaticus.
ECMO: Extracorporeal life support in patients with status asthmaticus when everything fails.
Reference: Click to get abstract
Use of ketamine in severe status asthmaticus in intensive care unit. Iran J Allergy Asthma Immunol. Dec 2003;2(4):175-80
Anaesthetic management in asthma. Minerva Anestesiol. Jun 2007;73(6):357-65.
Life-threatening status asthmaticus treated with inhaled nitric oxide - The Journal of Pediatrics, Volume 137, Issue 1, Pages 119-122
Emergency extracorporeal life support for asphyxic status asthmaticus. Respir Care. Nov 2007;52(11):1525-9.
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