• Gerald Wai Kit Ho, Thirumeninathan Thaarun, Neo Jean Ee, Teo Chong Boon, Koh Zheng Ning, Matthew Edward Cove, and Will Ne-Hooi Loh.
• Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore. gerald.ho@mohh.com.sg.
• Crit Care. 2024 Oct 14; 28 (1): 334334.

BackgroundTo conduct a systematic review looking into the use of sevoflurane in the management of status asthmaticus (SA) in adults.MethodsWe 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.ResultsA 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.ConclusionThe 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.© 2024. The Author(s).

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