Endotracheal intubation and pediatric status asthmaticus: Site of original care affects treatment*

Abstract

Children with status asthmaticus are more likely to be intubated, and intubated sooner, at a community hospital. The shorter duration of intubation suggests that some children may not have been intubated had they presented to a children's hospital or received more aggressive therapy at their community hospital.

β2-Adrenergic Receptor Haplotype Linked to Intubation and Mechanical Ventilation in Children with Asthma

“…More than 200,000 children are admitted to the hospital with asthma each year in the United States and 1 in 10 of these children are admitted to the intensive care unit (ICU) with severe and lifethreatening asthma (2,3). Of these, one in three has respiratory failure requiring endotracheal intubation and mechanical ventilation (4)(5)(6), and more than half of these intubated children have durations of mechanical ventilation of more than 3 days (5).…”

Intravenous Ketamine in a Dissociating Dose as a Temporizing Measure to Avoid Mechanical Ventilation in Adult Patient with Severe Asthma Exacerbation

“…Patients experiencing severe asthma exacerbation occasionally deteriorate to respiratory failure and require mechanical ventilation. Mechanical ventilation in the setting of severe asthma exposes the patient to substantial iatrogenic risks, including pneumothorax, pneumomediastinum, nosocomial pneumonia, worsening bronchospasm, and circulatory depression, and therefore should be utilized only after other measures have failed (6)(7)(8)(9).…”

Pediatric respiratory diseases: 2011 update for the Rogersʼ Textbook of Pediatric Intensive Care

“…In the current era, the likelihood that a child with status asthmaticus will receive NPPV as firstline mechanical support seems to depend on the setting in which he or she is first managed. A retrospective cohort study of children admitted to a university-affiliated pediatric ICU with status asthmaticus determined that children who originally presented to community hospitals were three times more likely to be intubated than their cohorts who first presented to the university-affiliated center, and they tended to receive less aggressive medical therapy before intubation (12). Furthermore, children intubated for asthma in the community hospital setting received significantly shorter courses of medical therapy for their asthma after initiation of mechanical ventilation.…”