KETAMINE INFUSION FOR REFRACTORY STATUS ASTHMATICUS: A CASE SERIES

Super-refractory status epilepticus (SRSE) represents a neurological emergency that is characterized by a lack of response to the third line of antiepileptic treatment, including intravenous general anesthetics. It is a medical challenge with high morbidity and mortality. Electroconvulsive therapy (ECT) has been recommended as a nonpharmacologic option of treatment after other alternatives are unsuccessful. Its effect on the cessation of SRSE has been minimally investigated. The objective of this article is to analyze the effect of ECT on SRSE. For this purpose, a multidisciplinary team created a protocol based on clinical guidelines similar to those described previously by Ray et al. (2017). ECT was applied to six patients with SRSE after the failure of antiepileptic treatment and pharmacologic coma.The objective of each ECT session was to elicit a motor seizure for at least 20 s. SRSE was resolved in all patients after several days of treatment, including ECT as a therapy, without relevant adverse effects. Thus, ECT is an effective and feasible option in the treatment of SRSE, and its place in the algorithm in treatment should be studied due to the uncommon adverse effects and the noninvasive character of the therapy.

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Combined bronchoscopy and mucolytic therapy for patients with severe refractory status asthmaticus on mechanical ventilation: A case report and review of the literature

Critical Care Medicine ◽

10.1097/00003246-199411000-00027 ◽

1994 ◽

Vol 22 (11) ◽

pp. 1880-1883 ◽

Cited By ~ 21

Author(s):

Craig A. Henke ◽

Marshall Hertz ◽

Paul Gustafson

Keyword(s):

Mechanical Ventilation ◽

Case Report ◽

Status Asthmaticus ◽

Review Of The Literature ◽

Refractory Status

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Ketamine infusion for refractory status epilepticus: A case report of cardiac arrest

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2017.10.044 ◽

2018 ◽

Vol 47 ◽

pp. 149-151 ◽

Cited By ~ 5

Author(s):

Lauren Koffman ◽

Ho Yan Yiu ◽

Salia Farrokh ◽

John Lewin ◽

Romergryko Geocadin ◽

...

Keyword(s):

Cardiac Arrest ◽

Case Report ◽

Status Epilepticus ◽

Refractory Status Epilepticus ◽

Ketamine Infusion ◽

Refractory Status

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Tracheobronchial mycosis in a retrospective case-series study of five status asthmaticus patients

Clinical Immunology ◽

10.1016/j.clim.2012.11.005 ◽

2013 ◽

Vol 146 (2) ◽

pp. 77-83 ◽

Cited By ~ 10

Author(s):

Garbo Mak ◽

Paul C. Porter ◽

Venkata Bandi ◽

Farrah Kheradmand ◽

David B. Corry

Keyword(s):

Status Asthmaticus ◽

Case Series ◽

Retrospective Case ◽

Retrospective Case Series ◽

Case Series Study ◽

Series Study

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The Treatment and Prognosis of Refractory and Super-Refractory Status Epilepticus

Neurology International Open ◽

10.1055/s-0043-110165 ◽

2017 ◽

Vol 01 (03) ◽

pp. E204-E210

Author(s):

Stephanie Gollwitzer ◽

Hajo Hamer

Keyword(s):

Status Epilepticus ◽

Electroconvulsive Therapy ◽

Case Reports ◽

Case Series ◽

Refractory Status Epilepticus ◽

Evidence Based ◽

New Approach ◽

Refractory Status ◽

First Choice ◽

Evidence Based Guidelines

AbstractRefractory status epilepticus (RSE) is defined as status epilepticus (SE) persisting over 60 min and resistant to treatment with benzodiazepines and non-sedating antiepileptic drugs. The term super-refractory status epilepticus (SRSE) refers to a refractory episode continuing under general anesthesia for more than 24 h. RSE is treated with a combination of non-sedating AED and i. v. anesthetics; first choice drugs are midazolam, propofol and thiopental. The management of super-refractory status epilepticus (SRSE) is challenging as clear evidence-based guidelines are lacking. Recommendations are mainly based on case reports and small case series. Therapeutic options include ketamine, inhalational anesthetics, steroids and immunoglobulins. Ketogenic diet, electroconvulsive therapy and epilepsy surgery are also considered as potentially effective. A promising new approach is the neurosteroid allopregnanolone. Mortality of RSE and SRSE is largely influenced by the etiology and is markedly higher as compared to non-refractory status epilepticus. It was reported to be about 30% and 50%, respectively.

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Use of continuous ketamine infusion as an adjunctive agent in neonates and infants with refractory and super refractory status epilepticus

10.21203/rs.3.rs-493872/v1 ◽

2021 ◽

Author(s):

Mackenzie N. DeVine ◽

Sharon E. Gordon ◽

Craig A. Press

Keyword(s):

Status Epilepticus ◽

Infusion Rate ◽

Hemodynamic Instability ◽

Refractory Status Epilepticus ◽

Older Children ◽

Safe Alternative ◽

Ketamine Infusion ◽

Young Infants ◽

Refractory Status ◽

Neonates And Infants

Abstract Background Continuous ketamine infusions have been studied as an adjunctive agent for refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) in older children and adults. However, minimal information exists on the efficacy, safety, and dosing for continuous ketamine in neonates and young infants. The purpose of our study was to review the safety and efficacy of continuous ketamine infusions in neonates and infants with RSE and super refractory status epilepticus (SRSE) at our institution. Methods Safety and clinical outcomes for neonates and infants who received continuous ketamine for RSE or SRSE at Children’s Hospital Colorado between June 2019 and June 2020 were retrospectively reviewed. Patients were included if they were less than or equal to 3 months of age and received continuous ketamine infusion for RSE defined as unresolved seizures despite administration of at least one first- and at least one second-line rescue medication or SRSE defined as unresolved seizures despite administration of third-line agents. Results We identified three patients who met inclusion criteria and received continuous ketamine infusion for RSE or SRSE during our study period. Patients included were refractory to an average of six anti-seizure medications prior to initiation of continuous ketamine infusion. Each patient was initiated on a continuous ketamine infusion rate of 1 mg/kg/hr with one patient requiring titration to a maximum of 6 mg/kg/hr. In one case, the concomitant use of continuous ketamine allowed for a reduction in benzodiazepine continuous infusion rate. In all cases, ketamine was well tolerated especially in the setting of hemodynamic instability. Conclusion Ketamine may provide a safe alternative in the acute setting in severe RSE and SRSE, especially in the setting of hemodynamic instability. This is the first small retrospective study to document the use of continuous ketamine as a treatment modality in neonates and infants with RSE or SRSE secondary to various underlying etiologies without adverse events.

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Successful treatment of refractory status asthmaticus with omalizumab: a case report

Allergy Asthma & Clinical Immunology ◽

10.1186/s13223-021-00629-z ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Jan Benes ◽

Roman Skulec ◽

Dalibor Jilek ◽

Ondrej Fibigr ◽

Vladimir Cerny

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Biological Treatment ◽

Status Asthmaticus ◽

Organ Support ◽

Hospital Death ◽

Line Treatment ◽

Invasive Ventilation ◽

Acute Setting ◽

Membrane Oxygenation ◽

Refractory Status

AbstractRefractory status asthmaticus is the cause of rare cases of in-hospital death due to acute bronchial asthma. The most severe cases unresponsive to first, second and next line treatment may be fatal despite aggressive organ support with invasive ventilation and extracorporeal membrane oxygenation. Omalizumab, a humanized recombinant monoclonal anti-IgE antibody, is an approved add-on biological treatment for severe asthma. However, it is not indicated in an acute setting. Here, we report the case of a young patient with status asthmaticus fully dependent on extracorporeal membrane oxygenation refractory to any therapy for six days, who was successfully treated with omalizumab.

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