Outcomes of paediatric critical care asthma patients

Rampersad, Neeta; Wilkins, Barry; Egan, Jonathan R.

doi:10.1111/jpc.13855

Cited by 7 publications

(12 citation statements)

References 20 publications

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“…Whilst asthma related PICU deaths in England (0.7%) were similar to those found in Australia (0.6%) and the Netherlands (0.6%) 17 , 18 , the reporting of asthma mortality in multi-centre PICU studies in the USA varied (0.3%, 1.9%, 4.3%) 19 , 21 , 30 . A UK study on general admissions in PICU using PICANet, found children who died in PICU stayed longer than who survived 31 , similar to our study.…”

Section: Discussionmentioning

confidence: 55%

“…Use of mechanical ventilation in children admitted to PICU in England (37.8%) is higher than that found in most other multi-centre reports from Australia (6–14%), the Netherlands (19%), while it varied in USA (19%, 3–47%) 17 , 18 , 21 , 46 . This may reflect a lower threshold for PICU admission in some countries, i.e.…”

Section: Discussionmentioning

confidence: 57%

“…It is quite probable that admissions coded as asthma represented other acute wheezing conditions, including acute viral induced wheeze 15 , 16 . Preschool admissions with a diagnosis of asthma were higher than those reported from other countries 5 , 17 – 25 . (ii) Due to confidentiality issues coupled with small numbers from Scotland, Wales and Northern Ireland or the PICU asthma deaths in England, detailed analyses from these episodes were not possible, thus limiting our ability to comment on reasons for regional variations or deaths 26 .…”

Section: Discussionmentioning

confidence: 74%

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Asthma in paediatric intensive care in England residents: observational study

Mukherjee

Cunningham

Bhuia

et al. 2022

Sci Rep

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Despite high prevalence of asthma in children in the UK, there were no prior report on asthma admissions in paediatric intensive care units (PICU). We investigated the epidemiology and healthcare resource utilisation in children with asthma presenting to PICUs in England. PICANet, a UK national PICU database, was queried for asthma as the primary reason for admission, of children resident in England from April 2006 until March 2013. There were 2195 admissions to PICU for a median stay of 1.4 days. 59% were males and 51% aged 0–4 years. The fourth and fifth most deprived quintiles represented 61% (1329) admissions and 73% (11) of the 15 deaths. Deaths were most frequent in 10–14 years age (n = 11, 73%), with no deaths in less than 5 years age. 38% of admissions (828/2193) received invasive ventilation, which was more frequent with increasing deprivation (13% (108/828) in least deprived to 31% (260/828) in most deprived) and with decreasing age (0–4-year-olds: 49%, 409/828). This first multi-centre PICU study in England found that children from more deprived neighbourhoods represented the majority of asthma admissions, invasive ventilation and deaths in PICU. Children experiencing socioeconomic deprivation could benefit from enhanced asthma support in the community.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 74%

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Asthma in paediatric intensive care in England residents: observational study

Mukherjee

Cunningham

Bhuia

et al. 2022

Sci Rep

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“…A study investigated outcomes of asthmatic patients admitted to the ICU revealed that the NIV use increased from 11 to 39% over 12 years. However, intubation rates remained similar despite increasing rates of NIV use (28).…”

Section: Asthmamentioning

confidence: 85%

Non-invasive Ventilation for Children With Chronic Lung Disease

2020

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Advances in medical care and supportive care options have contributed to the survival of children with complex disorders, including children with chronic lung disease. By delivering a positive pressure or a volume during the patient's inspiration, NIV is able to reverse nocturnal alveolar hypoventilation in patients who experience hypoventilation during sleep, such as patients with chronic lung disease. Bronchopulmonary dysplasia (BPD) is a common complication of prematurity, and despite significant advances in neonatal care over recent decades its incidence has not diminished. Most affected infants have mild disease and require a short period of oxygen supplementation or respiratory support. However, severely affected infants can become dependent on positive pressure support for a prolonged period. In case of established severe BPD, respiratory support with non-invasive or invasive positive pressure ventilation is required. Patients with cystic fibrosis (CF) and advanced lung disease develop hypoxaemia and hypercapnia during sleep and hypoventilation during sleep usually predates daytime hypercapnia. Hypoxaemia and hypercapnia indicates poor prognosis and prompts referral for lung transplantation. The prevention of respiratory failure during sleep in CF may prolong survival. Long-term oxygen therapy has not been shown to improve survival in people with CF. A Cochrane review on the use NIV in CF concluded that NIV in combination with oxygen therapy improves gas exchange during sleep to a greater extent than oxygen therapy alone in people with moderate to severe CF lung disease. Uncontrolled, non-randomized studies suggest survival benefit with NIV in addition to being an effective bridge to transplantation. Complications of NIV relate mainly to prolonged use of a face or nasal mask which can lead to skin trauma, and neurodevelopmental delay by acting as a physical barrier to social interaction. Another associated risk is pulmonary aspiration caused by vomiting whilst wearing a face mask. Adherence to NIV is one of the major barriers to treatment in children. This article will review the current evidence for indications, adverse effects and long term follow up including adherence to NIV in children with chronic lung disease.

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“…Studies were excluded if they included patients with no clear diagnosis of asthma and patients over 18 years. All probabilities were contrasted with probabilities extracted from local studies to derivate the ranges in the sensibility analisis (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Probabilitiesmentioning

confidence: 99%

The Cost‑Utility of Intravenous Magnesium Sulfate for Treating Acute Asthma in Children

Buendía

Cordero

Martínez

2020

Preprint

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Introduction Despite the evidence supporting the use of intravenous Magnesium Sulfate (MS) in acute asthma; this drug continues being considered as the second line in pediatric acute asthma exacerbations. This study aimed to evaluate the cost-effectiveness of the MS in acute asthma. Methods A decision tree model was used to estimate the Cost-utility study that compared MS versus standard treatment (control group) in an infant with acute asthma in the emergency setting. Cost data were obtained from a retrospective study on asthma from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. The analysis was carried out from a societal perspective. Results The model showed that MS for treating pediatric patient with acute asthma, was associated with lower total cost than standard therapy (US $1149 vs US $1598 average cost per patient), and higher QALYs ( 0.60 vs 0.52 average per patient); showing dominance. the probabilty that MS provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness to pay thresholds Conclusion MS in emergency settings was cost-effective for the hospital treatment of an infant with asthma moderate or severe. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

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Outcomes of paediatric critical care asthma patients

Cited by 7 publications

References 20 publications

Asthma in paediatric intensive care in England residents: observational study

Asthma in paediatric intensive care in England residents: observational study

Non-invasive Ventilation for Children With Chronic Lung Disease

The Cost‑Utility of Intravenous Magnesium Sulfate for Treating Acute Asthma in Children

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