Clinical Course and Outcome of Patients Admitted to an ICU for Status Asthmaticus

Afessa, Bekele; Morales, Ian J.; Cury, James

doi:10.1378/chest.120.5.1616

Cited by 84 publications

(63 citation statements)

References 17 publications

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“…(21,22) Our data regarding ICU admissions and in-hospital deaths are consistent with previous findings. (7) In the present study, 6.7% of all hospitalized asthma patients required ICU admission, and the mortality rate among patients admitted to the ICU was 8.3%. Few patients were submitted to intubation/mechanical ventilation, and the mortality rate among such patients was low (2.5%).…”

Section: Discussionmentioning

confidence: 45%

“…In general, such studies have evaluated cases over short periods of time and have been limited in their scope: conducted in individual facilities, limited to a small number of facilities or restricted to prescribed urban areas. (5)(6)(7)(8) In view of this lack of information, we conducted a study to evaluate modifications in the characteristics of patients hospitalized with acute severe asthma over a ten-year period (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004), in Spain and in eight Latin-American countries.…”

Section: Introductionmentioning

confidence: 99%

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The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

et al. 2009

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Objective: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. Methods: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-American countries. We reviewed the hospital records of 3,038 patients (age range, 15-69 years) hospitalized with acute severe asthma at one of nineteen tertiary-care hospitals in 1994, 1999 and 2004. Results: Over time, the use of inhaled corticosteroids and long-acting β 2 agonists increased significantly, whereas the use of theophylline as a controller medication decreased. The utilization of pulmonary function tests also increased. There was a significant reduction in the mean hospital stay (8.5 days, 7.4 days and 7.1 days in 1994, 1999 and 2004, respectively, p = 0.0001) and a significant increase in the mean of the lowest arterial pH at hospital admission. In contrast, there was a significant decrease in the proportion of cases in which PEF was determined in the emergency room (48.6% in 1994 vs. 43.5% in 2004, p = 0.0001). We found the quality of asthma management and care to be generally better in Spain than in Latin America. Conclusions: Although there have been certain improvements in the management of asthma between severe exacerbations and during hospitalization, asthma management remains suboptimal in Spain and, especially, in Latin America.Keywords: Status asthmaticus; Asthma/therapy; Hospitalization. ResumoObjetivo: Estudos que avaliem as características e o gerenciamento de pacientes asmáticos hospitalizados têm sido limitados a um número pequeno de serviços e a curtos períodos de duração. O presente estudo avaliou alterações de longo prazo de pacientes asmáticos hospitalizados em um grande número de serviços. Métodos: Estudo retrospectivo, observacional, de base hospitalar, denominado Estudo sobre Asma Grave na América Latina e Espanha, realizado na Espanha e em oito países da América Latina. Foi realizada uma revisão dos registros hospitalares de 3.038 pacientes (variação de idade, 15-69 anos) hospitalizados com asma aguda grave em um dos 19 hospitais terciários em 1994, 1999 e 2004. Resultados: Ao longo do tempo, o uso de corticosteroides inalatórios e de β 2 -agonistas aumentou significativamente, ao passo que o uso de teofilina, como medicação de controle, decaiu. A utilização de testes de função pulmonar também aumentou. Houve uma redução significativa da média do tempo de internação (8,5 dias, 7,4 dias e 7,1 dias em 1994, 1999 e 2004, respectivamente; p = 0,0001) e um aumento significativo da média do menor pH arterial na admissão. Em contrapartida, houve uma diminuição significativa na proporção de casos submetidos ao PFE no pronto-socorro (48,6% em 1994 vs. 43,5% em 2004; p = 0,0001).O tratamen...

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

et al. 2009

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“…9 However, in another study of 27 patients managed with NIV, 2 of the 5 patients requiring intubation died. 10 In 12 In our series, NIV was used in 10 patients, 4 of whom were subsequently intubated. The average time on NIV before intubation was 2 hours, and there were no deaths in this group.…”

Section: Discussionmentioning

confidence: 91%

Increasing severity of status asthmaticus in an urban medical intensive care unit

Elsayegh

Saito

Eden

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Life‐threatening status asthmaticus (SA) requiring intensive care is a major concern given the rising prevalence of asthma. We examined episodes of SA requiring admission to the medical intensive care unit (MICU) of an urban hospital center.METHODOLOGY:The charts of patients admitted to the MICU of an urban hospital center with a diagnosis of SA during the 5‐year period 2002–2006 were reviewed retrospectively. These results were compared with those of a previously published experience at our institution from 1995 to 1999.RESULTS:The medical records of 84 MICU admissions for SA were reviewed. There were 61 women (5 pregnant). The mean age was 44 years. Use of cigarettes or illicit drugs was found in 51% and 30%, respectively. Mechanical ventilation (MV) was required in 76% of admissions. Noninvasive ventilation was used in 10 patients. Neuromuscular blockade (NMB) was needed in 9% of admissions. The highest average PaCO2 during the first 24 hours was 67 mm Hg. Median duration of MV was 4.4 days. Six patients died, 3 of whom sustained prehospital cardiac arrest. Compared with the patients in the preceding 5‐year period, the more recent patients had greater use of illicit drug and cigarettes. Patients presented with more severe asthma, as reflected by a higher PaCO2 and an increased duration of MV.CONCLUSIONS:During the recent 5‐year period, we found a trend toward increasing severity of SA, as indicated by the degree of respiratory acidosis, need for NMB, and longer duration of MV. Access to medical care and cigarette and illicit drug use remain potential targets of primary intervention. Journal of Hospital Medicine 2008;3:206–211. © 2008 Society of Hospital Medicine.

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“…In addition, recent studies have reported that the incidence of asthma-related in-hospital mortality is higher among women than among men. (13)(14)18) Although it is difficult to understand why the mortality risk is greater for female patients hospitalized for asthma, it might be due to the gender bias (predominance of females) among adults with asthma. Among patients with severe asthma, the female/male ratio can be as high as 4:1.…”

Section: Discussionmentioning

confidence: 99%

Fatores associados à mortalidade em pacientes hospitalizados por asma aguda grave em 1994, 1999 e 2004 na Espanha e América Latina

et al. 2008

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Objective: To evaluate, for the first time, the characteristics of patients with acute asthma who died during hospitalization in Spain and Latin America, as well as to evaluate factors associated with asthma mortality. Methods: A retrospective review of hospital records of 3,038 patients with asthma (aged 15-69 years) admitted to nineteen tertiary care hospitals in Spain and in eight Latin-American countries in 1994, 1999, and 2004. Results: There were 25 deaths (0.8% of all hospitalized patients) during the three years studied. Although there was a tendency towards a reduction in in-hospital mortality (from 0.97% in 1994 to 0.69% in 2004), there were no significant differences in terms of year or geographic area. Intensive care unit admissions and cases of out of hospital cardiopulmonary arrest increased the mortality rates to 8.3% and 24.7%, respectively. The multivariate analysis showed that gender (female; OR = 25.5; 95% CI: 2.6-246.8), out of hospital cardiopulmonary arrest (OR = 22.5; 95% CI: 4.4-114.7), and arterial pH < 7.3 during hospitalization (OR = 1.0; 95% CI: 1.1-3.4) were strongly associated with asthma mortality. Conclusions: Our study on mortality in patients hospitalized for acute severe asthma showed that deaths occurred almost exclusively in female patients and in patients who suffered out of hospital cardiopulmonary arrest, confirming previous findings from studies conducted in developed countries.Keywords: Asthma/mortality; Asthma/epidemiology; Hospitalization; Hospital mortality. ResumoObjetivo: Avaliar, pela primeira vez, as características de pacientes com asma aguda que morreram durante a hospitalização na Espanha e na América Latina, bem como avaliar fatores associados à mortalidade por asma. Métodos: Revisão retrospectiva dos registros hospitalares de 3.038 pacientes com asma (com idade entre 15 e 69 anos) internados em dezenove hospitais de atendimento terciário na Espanha e em oito países da América Latina em 1994, 1999 e 2004. Resultados: Houve 25 mortes (0,8% de todos os pacientes hospitalizados) durante os três anos estudados. Embora tenha havido uma tendência de redução da mortalidade hospitalar (de 0,97% em 1994 para 0,69% em 2004), não houve diferenças significativas quanto ao ano ou à área geográfica. Internações em unidade de terapia intensiva e casos de parada pulmonar pré-hospitalar aumentaram as taxas de mortalidade para 8,3% e 24,7%, respectivamente. A análise multivariada mostrou que sexo (feminino; OR = 25,5; IC95%: 2,8), parada cardiopulmonar pré-hospitalar (OR = 22,5; IC95%: 4,4-114,7) e pH arterial < 7,3 durante a hospitalização (OR = 1,0; IC95%: 1,1-3,4) estavam fortemente associados à mortalidade por asma. Conclusões: Nosso estudo sobre mortalidade em pacientes hospitalizados por asma aguda grave mostrou que as mortes ocorreram quase que exclusivamente entre pacientes do sexo feminino e entre pacientes que sofreram parada cardiopulmonar pré-hospitalar, confirmando achados anteriores de estudos realizados em países desenvolvidos.

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Clinical Course and Outcome of Patients Admitted to an ICU for Status Asthmaticus

Cited by 84 publications

References 17 publications

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

Increasing severity of status asthmaticus in an urban medical intensive care unit

Fatores associados à mortalidade em pacientes hospitalizados por asma aguda grave em 1994, 1999 e 2004 na Espanha e América Latina

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