Background and Aims :
Asthma is a major cause of morbidity and mortality despite advances in outpatient treatment. Sometimes,
children fail to respond to standard treatment and can potentially require mechanical ventilation.
A case report :
A 3 years-old-boy with Prader willi syndrome was admitted in the peaditric intensive care unit (ICU) for respiratory distress and wheezing. He had a medical history of remarkable episodes of acute wheezing at aged 8 and 12 months. On admission, the patient displayed marked accessory muscle use and had an oxygen saturation of 90%. He received many doses of terbutaline 2 mg and ipratropium bromide 250 μg for an hour duration via a nebulizer device, as well as intramuscular Dexaméthasone ( 0.2mg/Kg). He had
become less responsive; oxygen saturation was only 92% on high-flow oxygen (10 l/min). Arterial blood gases showed pH 7.29; pCO2 = 9 Kpa and pO2 = 92. mmhg We decided to attempt ketamine nebulization (1mg/kg) as a last resort concomitantly with preparing the patient for a possible intubation. Twenty minutes after, the patient's respiratory status markedly improved, minimally audible wheezing on chest auscultation and oxygen saturation level increased to 98%. Blood gas analysis showed marked improvement: pH of 7.33,
pCO2 of 5 Kpa and pO2 of 100 mmhg . He did not experience any exacerbation overnight and was discharged from ICU 12 hours later.
Conclusion :
The uncommon use of nebulized ketamine in this case indicates that this route might be a promising option in the management of severe asthma exacerbation in children

NEBULIZED KETAMINE IN A PEDIATRIC PATIENT WITH SEVERE ASTHMA EXACERBATION