Cooling in status asthmaticus

Motivation: A case of status asthmaticus refractory to continuous nebs, steroids, theophylline, heliox, etc. Ventilation was a major issue, with severe respiratory acidosis and unacceptably high plateau pressures, despite optimization of vent settings and paralysis. This patient was cooled in an attempt to decrease the body's CO2 production, in the hope of decreasing PaCO2 and the patient's overall ventilatory requirement. Physiologically, this makes sense, but what has the literature reported about similar cases?

Literature search and results: Looking into the literature, there is a case published about treatment of severe asthma with hypothermia: Browning D, Goodrum DT. Treatment of acute severe asthma assisted by hypothermia. Anaesthesia. 1992 Mar;47(3):223-5. In this case report, a patient in refractory status asthmaticus was cooled to 30 degrees Celsius for 5 days due to rising PaCO2. While hypothermia helped with ventilatory settings, her ventilation was compromised by development of steroid-induced myopathy.

Discussion: My search for similar cases came up quite short. Hypothermia was used in our case and in this reported case in the literature was in the setting of status asthmaticus with poor/very guarded prognosis despite maximal therapy and optimal support. As predicted by physiology, cooling helped with allowing more reasonable vent parameters, but could not change the underlying process and complications related to status asthmaticus and its necessary therapies (e.g. steroid side effects, infections secondary to vent/lines/etc.). Furthermore, cooling/rewarming  is associated with its own complications. Thus, hypothermia can be seen as a temporizing agent to be considered within a plethora of medical issues in these severe cases of status asthmaticus.