Acute iterative bronchospasm and "do not re-intubate" orders: sedation by an alpha-2 agonist combined with noninvasive ventilation

作者：Galland C; Sergent B; Pichot C; Ghignone M; Quintin L^*

来源：American Journal of Emergency Medicine, 2015, 33(6): 857.e3.

DOI：10.1016/j.ajem.2014.11.053

A male patient presented with bronchospasm and acute respiratory distress. The patient had presented 2 previous episodes of severe bronchospasm following abdominal surgery, leading twice to intubation, mechanical ventilation, and conventional sedation. As the patient positively rejected a third episode of intubation + mechanical ventilation, noninvasive ventilation (pressure support = 8 cm H(2)0, positive endexpiratory pressure = 10 cm H(2)0), inhaled therapy, and clonidine orally (approximate to 4 mu g/kg) were combined. Over 1 to 2 hours, the acute respiratory distress disappeared. Noninvasive ventilation was discontinued on the next morning (day 2). The patient was discharged from the critical care unit on day 3 on good condition but died at a later interval from iterative bronchospasm. Evidence-based documentation of the effects of alpha-2 agonists in the setting of acute bronchospasmin the emergency department or status asthmaticus in the critical care unit is awaited.

• 出版日期2015-6