Ketamine to avoid mechanical ventilation in severe pediatric asthma

Children experiencing severe asthma exacerbations may deteriorate to respiratory failure requiring endotracheal intubation and mechanical ventilation. Mechanical ventilation is often life saving in this setting, but also exposes the asthmatic child to substantial iatrogenic risk. We present two cases of severe asthma exacerbations in prepubertal children for whom the administration of a bolus of intravenous ketamine followed by a continuous infusion of a relatively large dose of ketamine led to prompt improvement, obviating the need for mechanical ventilation. These cases suggest that for children experiencing severe asthma exacerbations, intravenous ketamine may be an effective temporizing measure to avoid exposing these children to the risks associated with mechanical ventilation.