Fatal and Near-Fatal Asthma in Children: The Critical Care Perspective

Abstract

Objective To characterize the clinical course, therapies, and outcomes of children with fatal and near-fatal asthma admitted to the pediatric intensive care unit (PICU). Study design Retrospective chart abstraction across the eight tertiary-care PICUs in the Collaborative Pediatric Critical Care Research Network (CPCCRN). Inclusion criteria: children (1–18 years) admitted 2005 to 2009 (inclusive) for asthma receiving ventilation (near-fatal) or died (fatal). Data collected included medications, ventilator strategies, concomitant therapies, demographics and risk variables. Results Of 261 eligible children, 33 (13%) had no previous history of asthma, 218 (84%) survived with no known complications, and 32 (12%) had complications. Eleven (4%) died, 10 having had cardiac arrest before admission. Patients intubated outside the PICU had shorter ventilation (median 25 vs. 84 hours, p<0.001). African-Americans were disproportionately represented by numbers intubated and had shorter durations of intubation. Barotrauma occurred in 15 (6%) children before admission. Pharmacological therapies were highly variable with similar outcomes. Conclusions Of children ventilated in CPCCRN PICUs, 96% survived to hospital discharge. Most children who died experienced cardiac arrest prior to admission. Intubation outside the PICU was correlated with shorter ventilation duration. The complications of barotrauma and neuromyopathy were uncommon. Practice patterns varied widely between CPCCRN sites.

Underuse of guideline-recommended long-term asthma management in children hospitalized to the intensive care unit: a multicenter observational study

“…Median household income was estimated using home zip codes. 10 Primary care was defined as coordinated, comprehensive, longitudinal care including prevention, and primary care practitioner included family physician, internist, or nurse practitioner regardless of payer assignment or duration of longitudinal care. Specialty care was defined as outpatient asthma care by an allergist/immunologist, pulmonologist, or other physician specifically focusing on asthma care (eg, a general pediatrician who is director of the local asthma center).…”

“…Alternatively, the population with asthma exacerbation may be similar in severity, 4 whereas the criteria for ICU admission changed and their resource use increased. A lack of consensus among clinicians as to the best practices, suggested by a wide practice variation for care of the children with severe asthma exacerbation, 8,10,12 might, in part, contribute to this phenomenon.…”

Volatile anesthetics and the treatment of severe bronchospasm: a concept of targeted delivery

“…Asthma is particularly prevalent in children, and has exhibited a steady increase over the past few decades [9,18]. Acute exacerbations range from mild to severe, with the latter being responsible for nearly half a million admissions to the pediatric intensive care unit (PICU) each year [19-21].…”

Paediatric ED BiPAP continuous quality improvement programme with patient analysis: 2005–2013

“…An increasing percentage of paediatric patients with status asthmaticus require adjunct asthma therapy (different β-2 agonist agents, pressure-driven aerosols delivery systems (positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP)), intravenous (IV) magnesium sulfate, systemic β-2 agonist), in the paediatric emergency department (PED) 1–3. These patients have increased inspiratory and expiratory airway obstruction producing significant dynamic hyperinflation and ineffective ventilation causing an increasing inspiratory work of breathing resulting in inspiratory muscle fatigue 4–6.…”