Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Crit Care. 2024 Oct 14;28(1):334. doi: 10.1186/s13054-024-05122-8.
To conduct a systematic review looking into the use of sevoflurane in the management of status asthmaticus (SA) in adults.
We performed a systematic search on PubMed, EMBASE, and The Cochrane Library - CENTRAL through 23rd August 2023, restricting to studies reported in English. We included studies reporting use of sevoflurane in asthmatics beyond its use as an anaesthetic agent in surgeries i.e. in the emergency department (ED) and critical care setting, and focused on patient's clinical parameters, ventilation pressures and weaning of invasive ventilation.
A total of 13 publications fulfilled the inclusion criteria, comprising of 18 cases. All publications were of case reports/ series and conference abstracts, and no randomised trials were available. Most patients required intubation despite best medical management before sevoflurane administration, and high airway pressures and respiratory acidosis were apparent. There was significant heterogeneity regarding severity of asthma, treatment instituted, and the delivery, duration and concentration of sevoflurane administered. Many of the studies also did not quantify the changes in parameters pre- and post-sevoflurane. Sixteen patients experienced improvements in clinical status with sevoflurane administration-one required escalation to extracorporeal membrane oxygenation (ECMO), and another did not survive.
The systematic review suggests sevoflurane can be a valuable treatment option in SA. As these cases are rare and heterogenous, further prospective case series are needed to support this.
进行一项系统评价，旨在研究七氟醚在成人哮喘持续状态（SA）管理中的应用。
我们在 2023 年 8 月 23 日之前在 PubMed、EMBASE 和 The Cochrane Library-CENTRAL 上进行了系统搜索，仅限于以英文报告的研究。我们纳入了报告在哮喘患者中使用七氟醚的研究，这些研究不仅限于手术中（即急诊科和重症监护病房）作为麻醉剂使用，还关注患者的临床参数、通气压力和有创通气的脱机。
共有 13 篇文献符合纳入标准，共包括 18 例病例。所有文献均为病例报告/系列和会议摘要，无随机试验。尽管在使用七氟醚之前已进行了最佳的药物治疗，但大多数患者仍需要插管，并且气道压力高和呼吸性酸中毒明显。关于哮喘严重程度、所采用的治疗方法以及七氟醚的给予方式、持续时间和浓度，存在显著的异质性。许多研究也没有量化七氟醚给药前后参数的变化。16 名患者在使用七氟醚后临床状况得到改善——1 名患者需要升级到体外膜氧合（ECMO），另 1 名患者未存活。
系统评价表明，七氟醚可能是 SA 的一种有价值的治疗选择。由于这些病例罕见且异质性较大，需要进一步的前瞻性病例系列研究来支持这一结论。
