A 10-year-old boy is currently in the pediatric intensive care unit for the management of refractory status asthmaticus. He presented to the emergency department 12 hours ago with severe wheezing, dyspnea, and hypoxia. Despite maximized medical therapy with continuous nebulized albuterol, intravenous magnesium sulfate, and systemic corticosteroids, he developed progressive respiratory failure requiring intubation and mechanical ventilation. Ten minutes ago, his blood pressure precipitously dropped, and he became tachycardic.

He appears deeply sedated and is mechanically ventilated. He is afebrile. His blood pressure is 65/40 mmHg with a heart rate of 155 bpm and an oxygen saturation of 89% on 100% fraction of inspired oxygen.