BACKGROUND
Near-fatal status asthmaticus remains a life-threatening condition in which evidence guiding management beyond conventional therapies is limited. When effective ventilation cannot be achieved despite invasive mechanical ventilation and standard medical treatment, therapeutic options become increasingly uncertain.
CASE REPORT
An 18-year-old woman with a history of asthma developed near-fatal refractory status asthmaticus requiring endotracheal intubation and intensive care admission. Despite invasive mechanical ventilation, continuous nebulized salbutamol, systemic corticosteroids, intravenous magnesium sulfate, and sedation, profound hypercapnic and hypoxemic respiratory failure persisted (pH 6.94, PaCO₂ 106 mm Hg, and PaO₂ 49 mm Hg at an FiO₂ of 1.0), with critically reduced tidal volumes and markedly elevated airway pressures. Endotracheal epinephrine was administered as a rescue intervention and this was followed by rapid improvement in ventilatory mechanics, oxygenation, and gas exchange. PaO₂ subsequently increased to 64 mm Hg at an FiO₂ of 0.60, corresponding to an improvement in the PaO₂/FiO₂ ratio from 49 to approximately 107. Recurrent ventilatory deterioration developed on 2 occasions and was again followed by prompt improvement after repeated endotracheal epinephrine administration. The patient ultimately recovered, was successfully liberated from invasive mechanical ventilation, and was discharged without neurological sequelae.
CONCLUSIONS
In this patient with near-fatal refractory status asthmaticus, repeated endotracheal epinephrine administration was temporally associated with rapid improvements in ventilatory function during episodes of recurrent deterioration. Because multiple concurrent therapies were administered, causality cannot be established. This observation should be regarded as hypothesis-generating and may warrant further investigation in carefully selected patients with extreme refractory disease after standard therapies have been optimized.

Keywords: Status Asthmaticus; Ventilation; Epinephrine; Salvage Therapy