Subarachnoid hemorrhage in a child with status asthmaticus: Significance of permissive hypercapnia

OBJECTIVE: To report an 11-yr-old boy with acute status asthmaticus being managed with permissive hypercapnia who developed a subarachnoid hemorrhage during the course of his illness. SETTING: An eight-bed pediatric intensive care unit in a community hospital. INTERVENTIONS: The patient was intubated for respiratory failure and managed with permissive hypercapnia. After the development of changes in his pupillary exam, computerized tomography of the brain revealed diffuse subarachnoid hemorrhage. Carotid angiography was performed to rule out the possibility of underlying vascular malformation. RESULTS: Aggressive investigation including a normal carotid angiogram failed to reveal underlying pathology that may have put the patient at risk for the event. CONCLUSIONS: We conclude that this patient suffered subarachnoid hemorrhage in association with the use of permissive hypercapnia in the settling of severe asthma.