Use of ketamine in asthmatic children to treat respiratory failure refractory to conventional therapy

We treated two pediatric patients suffering respiratory failure associated with status asthmaticus. Neither patient responded to maximal bronchodilatory therapy and mechanical ventilation; however, continuous infusion of ketamine (1.0 to 2.5 mg/kg·h) immediately improved airway obstruction. Ketamine appears to increase catecholamine levels and directly relax bronchial smooth muscle. Except for increased secretions during the infusion, our patients showed no immediate or longterm sequelae from ketamine therapy. However, ketamine should only be used for asthmatics whose respiratory failure does not respond to conventional management and mechanical ventilation.