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.

中文翻译：

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使用七氟烷治疗成人哮喘持续状态的系统评价


进行系统评价，探讨七氟烷在成人哮喘持续状态 （SA） 管理中的应用。截至 2023 年 8 月 23 日，我们对 PubMed、EMBASE 和 Cochrane 图书馆 – CENTRAL 进行了系统检索，仅限于以英文报告的研究。我们纳入了报告七氟烷在哮喘患者中的使用研究，这些研究超出了在手术中用作麻醉剂，即在急诊科 （ED） 和重症监护环境中，并侧重于患者的临床参数、通气压力和有创通气脱机。共有 13 篇出版物符合纳入标准，包括 18 篇病例。所有出版物都是病例报告/系列和会议摘要，没有随机试验可用。尽管在七氟烷给药前进行了最好的药物治疗，但大多数患者需要插管，并且高气道压力和呼吸性酸中毒很明显。在哮喘的严重程度、开始的治疗以及施用的七氟烷的给药、持续时间和浓度方面存在显著的异质性。许多研究也没有量化七氟烷前后参数的变化。16 例患者在服用七氟烷后临床状态有所改善，1 例需要升级至体外膜肺氧合 （ECMO），1 例未存活。系统评价表明，七氟烷可能是 SA 的一种有价值的治疗选择。由于这些病例罕见且异质性，因此需要进一步的前瞻性病例系列来支持这一点。