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ISSN 2007-1752 (Print)
Archivos de Medicina de Urgencia de México

2026, Number 1

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Arch Med Urg Mex 2026; 18 (1)

Overcoming refractoriness: sevoflurane as a last-resort therapy in the management of near-fatal status asthmaticus. A Case Report

Palominos-Gutiérrez YA, Montelongo FJ, Galindo-Ayala J, Tapia-Velasco R, Salazar-Mendoza A, Trujillo-Martínez M

Language: Spanish
References: 15
Page: 111-116
PDF size: 601.76 Kb.


ABSTRACT

Introduction: status asthmaticus is a severe and potentially life-threatening asthma exacerbation characterized by persistent airflow obstruction, hypercapnia, and respiratory failure. In a subset of patients, severe bronchospasm persists despite optimal conventional therapy, including bronchodilators, systemic corticosteroids, adjunctive therapies, and invasive mechanical ventilation, resulting in refractory status asthmaticus.
Results and discussion: we report the case of a 31-year-old male with a history of asthma admitted to the intensive care unit (ICU) with severe status asthmaticus, profound respiratory acidosis, and extreme hypercapnia, refractory to multiple pharmacologic and ventilatory interventions, including inhaled bronchodilators, systemic corticosteroids, magnesium sulfate, aminophylline, deep sedation, and neuromuscular blockade. Due to failure of maximal medical therapy, inhaled sevoflurane was initiated as rescue therapy. This intervention was associated with progressive improvement in gas exchange, normalization of PaCO₂ levels, reduction in ventilatory pressures, and hemodynamic stabilization, allowing successful withdrawal of vasopressor and ventilatory support.
Conclusion: inhaled sevoflurane may be considered an effective rescue therapy in selected cases of refractory status asthmaticus managed in the ICU. Its use should be reserved for exceptional situations and performed under strict monitoring in specialized centers.


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