1
|
Asthma in paediatric intensive care in England residents: observational study. Sci Rep 2022; 12:1315. [PMID: 35079067 PMCID: PMC8789863 DOI: 10.1038/s41598-022-05414-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023] Open
Abstract
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.
Collapse
|
2
|
van den Berg S, Hashimoto S, Golebski K, Vijverberg SJH, Kapitein B. Severe acute asthma at the pediatric intensive care unit: can we link the clinical phenotypes to immunological endotypes? Expert Rev Respir Med 2021; 16:25-34. [PMID: 34709100 DOI: 10.1080/17476348.2021.1997597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The clinical phenotype of severe acute asthma at the pediatric intensive care unit (PICU) is highly heterogeneous. However, current treatment is still based on a 'one-size-fits-all approach'. AREAS COVERED We aim to give a comprehensive description of the clinical characteristics of pediatric patients with severe acute asthma admitted to the PICU and available immunological biomarkers, providing the first steps toward precision medicine for this patient population. A literature search was performed using PubMed for relevant studies on severe acute (pediatric) asthma. EXPERT OPINION Omics technologies should be used to investigate the relationship between cellular molecules and pathways, and their clinical phenotypes. Inflammatory phenotypes might guide bedside decisions regarding the use of corticosteroids, neutrophil modifiers and/or type of beta-agonist. A next step toward precision medicine should be inclusion of these patients in clinical trials on biologics.
Collapse
Affiliation(s)
- Sarah van den Berg
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Hashimoto
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Korneliusz Golebski
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Berber Kapitein
- Departmentof Pediatric Pulmonology, Amsterdam Public Health Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Kulalert P, Phinyo P, Patumanond J, Smathakanee C, Chuenjit W, Nanthapisal S. Factors Associated with Failure of Intermittent Nebulization with Short-Acting Beta-Agonists in Children with Severe Asthma Exacerbation. J Asthma Allergy 2020; 13:275-283. [PMID: 32904643 PMCID: PMC7457559 DOI: 10.2147/jaa.s258549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Intermittent nebulization of short-acting beta-agonists (SABA) is the initial treatment of choice for children with asthma exacerbation. However, children with severe asthma exacerbation (SAE) may not show an adequate response and need aggressive stepwise therapy. We aimed to explore factors associated with a poor response to intermittent nebulized SABA in children with SAE. Methods A retrospective cohort study of children with SAE diagnosed according to the definition of the British Guidelines on the Management of Asthma, who were admitted at Hat Yai Hospital from January 1, 2015, to December 31, 2017. All children were treated with intermittent SABA nebulization. Treatment failure was defined as children needing escalated therapy. Logistic regression with confounding score adjustment was used to explore the predictors of treatment failure. Results One hundred thirty-three children were included in the analysis, 59 were in the failure group and 74 were in the success group. After adjusting for potential confounders, they were significantly associated with a previous history of intubation (adjusted OR 6.46, 95% CI 1.13 to 36.79, p=0.036), receiving <3 doses of nebulized salbutamol in the emergency room (ER, aOR 3.21, 95% CI 1.15 to 9.02, p=0.027), ER measured oxygen saturation (SpO2) <92% (adjusted OR 3.02, 95% CI 1.18 to 7.75, p=0.022), and exacerbation triggered by pneumonia (adjusted OR 2.67, 95% CI 1.19 to 6.00, p=0.017). Conclusion We identified four prognostic factors of treatment failure in children with SAE: a previous history of intubation; receiving <3 doses of nebulized salbutamol in the ER, SpO2 at ER <92%; and exacerbation triggered by pneumonia. Further prospective studies are required to confirm our findings before clinical implementation.
Collapse
Affiliation(s)
- Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Sira Nanthapisal
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| |
Collapse
|
4
|
Kulalert P, Phinyo P, Patumanond J, Smathakanee C, Chuenjit W, Nanthapisal S. Continuous versus intermittent short-acting β2-agonists nebulization as first-line therapy in hospitalized children with severe asthma exacerbation: a propensity score matching analysis. Asthma Res Pract 2020; 6:6. [PMID: 32632352 PMCID: PMC7329360 DOI: 10.1186/s40733-020-00059-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Short-acting β2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. Either intermittent or continuous delivery has been considered safe and efficient. The comparative efficacy of these two modalities is inconclusive. We aimed to compare these two modalities as the first-line treatments. Methods An efficacy research with a retrospective cohort study design was conducted. Hospital records of children with severe asthma exacerbation admitted to Hat Yai Hospital between 2015 and 2017 were retrospectively collected. Children initially treated with continuous salbutamol 10 mg per hour or intermittent salbutamol 2.5 mg per dose over 1–4 h nebulization were matched one-to-one using the propensity score. Competing risk and risk difference regression was applied to evaluate the proportion of children who succeeded and failed the initial treatment. Restricted mean survival time regression was used to compare the length of stay (LOS) between the two groups. Results One-hundred and eighty-nine children were included. Of these children, 112 were matched for analysis (56 with continuous and 56 with intermittent nebulization). Children with continuous nebulization experienced a higher proportion of success in nebulization treatment (adjusted difference: 39.5, 95% CI 22.7, 56.3, p < 0.001), with a faster rate of success (adjusted SHR: 2.70, 95% CI 1.73, 4.22, p < 0.001). There was a tendency that LOS was also shorter (adjusted mean difference − 9.9 h, 95% CI -24.2, 4.4, p = 0.176). Conclusion Continuous SABA nebulization was more efficient than intermittent nebulization in the treatment of children with severe asthma exacerbation.
Collapse
Affiliation(s)
- Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Sira Nanthapisal
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| |
Collapse
|
5
|
Boeschoten S, de Hoog M, Kneyber M, Merkus P, Boehmer A, Buysse C. Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey. Eur J Pediatr 2020; 179:455-461. [PMID: 31797080 PMCID: PMC7028840 DOI: 10.1007/s00431-019-03502-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/10/2019] [Accepted: 10/09/2019] [Indexed: 12/30/2022]
Abstract
Most pediatric asthma guidelines offer evidence-based or best practice approaches to the management of asthma exacerbations but struggle with evidence-based approaches for severe acute asthma (SAA). We aimed to investigate current practices in children with SAA admitted to European pediatric intensive care units (PICUs), in particular, adjunct therapies, use of an asthma severity score, and availability of a SAA guideline. We designed a cross-sectional electronic survey across European PICUs. Thirty-seven PICUs from 11 European countries responded. In 8 PICUs (22%), a guideline for SAA management was unavailable. Inhaled beta-agonists and anticholinergics, combined with systemic steroids and IV MgSO4 was central in SAA treatment. Seven PICUs (30%) used a loading dose of a short-acting beta-agonist. Eighteen PICUs (49%) used an asthma severity score, with 8 different scores applied. Seventeen PICUs (46%) observed an increasing trend in SAA admissions.Conclusion: Variations in the treatment of children with SAA mainly existed in the use of adjunct therapies and asthma severity scores. Importantly, in 22% of the PICUs, a SAA guideline was unavailable. Standardizing SAA guidelines across PICUs in Europe may improve quality of care. However, the limited number of PICUs represented and the data compilation method are constraining our findings.What is Known:• Recent reports demonstrate increasing numbers of children with SAA requiring PICU admission in several countries across the world.• Most pediatric guidelines offer evidence-based approaches to the management of asthma exacerbations, but struggle with evidence-based approaches for SAA beyond these initial steps.What is New:• A large arsenal of adjunct therapies and 8 different asthma scores were used.• In a large number of PICUs, a written guideline for SAA management is lacking.
Collapse
Affiliation(s)
- Shelley Boeschoten
- Department of Pediatric Intensive Care Unit/Pediatric Surgery, Erasmus Medical Centre, Sophia's Children Hospital, PO Box 2060, 3000CB, Rotterdam, The Netherlands.
| | - Matthijs de Hoog
- Department of Pediatric Intensive Care Unit/Pediatric Surgery, Erasmus Medical Centre, Sophia’s Children Hospital, PO Box 2060, 3000CB Rotterdam, The Netherlands
| | - Martin Kneyber
- Department of Pediatrics, Division of Pediatric Intensive Care, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Merkus
- Division of Respiratory Medicine, Department of Pediatrics, Radboud University Medical Centre Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - Annemie Boehmer
- Department of Pediatrics, Erasmus Medical Centre, Sophia’s Children Hospital and Maasstad Hospital, Rotterdam, The Netherlands
| | - Corinne Buysse
- Department of Pediatric Intensive Care Unit/Pediatric Surgery, Erasmus Medical Centre, Sophia’s Children Hospital, PO Box 2060, 3000CB Rotterdam, The Netherlands
| |
Collapse
|
6
|
Miller AG, Haynes KE, Gates RM, Zimmerman KO, Heath TS, Bartlett KW, McLean HS, Rehder KJ. A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit. Respir Care 2019; 64:1325-1332. [PMID: 31088987 DOI: 10.4187/respcare.06626] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist-driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU. METHODS We retrospectively reviewed the medical records of all pediatric asthma subjects 2-17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distributed data, and the Mann-Whitney test for nonparametric data. RESULTS A total of 203 eligible subjects (49 in the pre-pathway group, 154 in the post group) were enrolled. There were no differences between groups for age, weight, gender, home medications, cause of exacerbation, medical history, or route of admission. There were significant decreases in median (interquartile range) hospital LOS (4.4 [2.9-6.6] d vs 2.7 [1.6-4.0] d, P < .001), median PICU LOS (2.1 [1.3-4.0] d vs 1.6 [0.8-2.4] d, P = .003), and median time on continuous albuterol (39 [25-85] h vs 27 [13-42] h, P = .001). Significantly more subjects in the post-pathway group were placed on high-flow nasal cannula (32% vs 6%, P = .001) or noninvasive ventilation (10% vs 4%, P = .02). CONCLUSION The implementation of an asthma pathway was associated with decreased hospital LOS, PICU LOS, and time on continuous albuterol. There was also an increase in the use of high-flow nasal cannula and noninvasive ventilation after the implementation of this clinical pathway.
Collapse
Affiliation(s)
- Andrew G Miller
- Respiratory Care Services at Duke University Medical Center, Durham, North Carolina.
| | - Kaitlyn E Haynes
- Respiratory Care Services at Duke University Medical Center, Durham, North Carolina
| | - Rachel M Gates
- Respiratory Care Services at Duke University Medical Center, Durham, North Carolina
| | - Kanecia O Zimmerman
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
| | - Travis S Heath
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina
| | - Kathleen W Bartlett
- Division of Pediatric Hospital Medicine, Duke University Medical Center, Duke University Medical Center, Durham, North Carolina
| | - Heather S McLean
- Division of Pediatric Hospital Medicine, Duke University Medical Center, Duke University Medical Center, Durham, North Carolina
| | - Kyle J Rehder
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
7
|
Herrera AM, Brand P, Cavada G, Koppmann A, Rivas M, Mackenney J, Sepúlveda H, Wevar ME, Cruzat L, Soto S, Pérez MA, León A, Contreras I, Alvarez C, Walker B, Flores C, Lezana V, Garrido C, Herrera ME, Rojas A, Andrades C, Chala E, Martínez RA, Vega M, Perillán JA, Seguel H, Przybyzsweski I. Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study. Allergol Immunopathol (Madr) 2019; 47:282-288. [PMID: 30595390 PMCID: PMC7125869 DOI: 10.1016/j.aller.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.
Collapse
Affiliation(s)
- A M Herrera
- Santa María Clinic, Santa María 500, Santiago, Zip Code 7520378 Región Metropolitana, Chile; School of Medicine, Los Andes University, Monseñor Alvaro del Portillo 12455, Santiago, Zip Code 7620001 Región Metropolitana, Chile.
| | - P Brand
- Isala Women's and Children's Hospital, Zwolle, The Netherlands
| | - G Cavada
- School of Medicine, Finis Terrae University, Av Providencia 1509, Santiago, Zip Code 7501015 Región Metropolitana, Chile
| | - A Koppmann
- San Borja Arriarán Hospital, Av Santa Rosa 1234, Santiago, Zip Code 8360160 Región Metropolitana, Chile; School of Medicine, University of Chile, Chile
| | - M Rivas
- San Borja Arriarán Hospital, Av Santa Rosa 1234, Santiago, Zip Code 8360160 Región Metropolitana, Chile
| | - J Mackenney
- Roberto del Río Hospital, Av Profesor Zañartu 1085, Santiago, Zip Code 8380418 Región Metropolitana, Chile; School of Medicine, University of Chile, Chile
| | - H Sepúlveda
- Luis Calvo Mackenna Hospital, Av Antonio Varas 360, Santiago, Zip Code 7500539 Región Metropolitana, Chile
| | - M E Wevar
- Luis Calvo Mackenna Hospital, Av Antonio Varas 360, Santiago, Zip Code 7500539 Región Metropolitana, Chile
| | - L Cruzat
- Luis Calvo Mackenna Hospital, Av Antonio Varas 360, Santiago, Zip Code 7500539 Región Metropolitana, Chile
| | - S Soto
- Concepción Regional Hospital, San Martín 1436, Concepción, Zip Code 4070038 Región del Bío Bío, Chile
| | - M A Pérez
- Santa María Clinic, Santa María 500, Santiago, Zip Code 7520378 Región Metropolitana, Chile
| | - A León
- Santa María Clinic, Santa María 500, Santiago, Zip Code 7520378 Región Metropolitana, Chile
| | - I Contreras
- Padre Hurtado Hospital, Esperanza 2150, Santiago, Zip Code 8880465 Región Metropolitana, Chile
| | - C Alvarez
- Alemana Clinic, Av Vitacura 5951, Santiago, Zip Code 7650568 Región Metropolitana, Chile; School of Medicine, Desarrollo University, Av Las Condes 12496, Santiago, Zip Code 7590943 Región Metropolitana, Chile
| | - B Walker
- Alemana Clinic, Av Vitacura 5951, Santiago, Zip Code 7650568 Región Metropolitana, Chile; School of Medicine, Desarrollo University, Av Las Condes 12496, Santiago, Zip Code 7590943 Región Metropolitana, Chile
| | - C Flores
- Ovalle Hospital, Ariztía Pte. 7, Ovalle, Zip Code 1842054 Región de Coquimbo, Chile
| | - V Lezana
- Gustavo Fricke Hospital, Av Alvarez 1532, Viña del Mar, Zip Code 2570017 Región de Valparaíso, Chile
| | - C Garrido
- Gustavo Fricke Hospital, Av Alvarez 1532, Viña del Mar, Zip Code 2570017 Región de Valparaíso, Chile
| | - M E Herrera
- José Joaquín Aguirre Hospital, Santos Dumont 999, Santiago, Zip Code 8380456 Región Metropolitana, Chile
| | - A Rojas
- José Joaquín Aguirre Hospital, Santos Dumont 999, Santiago, Zip Code 8380456 Región Metropolitana, Chile
| | - C Andrades
- Valdivia Hospital, Coronel Santiago Bueras y Avaria 1003, Valdivia, Zip Code 5090146 Región de los Ríos, Chile
| | - E Chala
- Fusat Hospital, Carretera el Cobre Presidente Frei Montalva 1002, Zip Code 2820945 Rancagua, VI Región, Chile; School of Medicine, Los Andes University, Monseñor Alvaro del Portillo 12455, Santiago, Zip Code 7620001 Región Metropolitana, Chile
| | - R A Martínez
- Fusat Hospital, Carretera el Cobre Presidente Frei Montalva 1002, Zip Code 2820945 Rancagua, VI Región, Chile
| | - M Vega
- Leonardo Guzmán Hospital, Veintiuno de Mayo 1310, Zip Code 1271847 Antofagasta, Región de Antofagasta, Chile
| | - J A Perillán
- San Juan De Dios Hospital, Huérfanos 3255, Zip Code 8350488 Santiago, Región Metropolitana, Chile; School of Medicine, University of Chile, Chile
| | - H Seguel
- San Juan De Dios Hospital, Huérfanos 3255, Zip Code 8350488 Santiago, Región Metropolitana, Chile
| | - I Przybyzsweski
- San Juan De Dios Hospital, Huérfanos 3255, Zip Code 8350488 Santiago, Región Metropolitana, Chile
| |
Collapse
|
8
|
Abdelkarim H, Durie M, Bellomo R, Bergmeir C, Badawi O, El-Khawas K, Pilcher D. A comparison of characteristics and outcomes of patients admitted to the ICU with asthma in Australia and New Zealand and United states. J Asthma 2019; 57:398-404. [PMID: 30701997 DOI: 10.1080/02770903.2019.1571082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To compare the characteristics, use of invasive ventilation and outcomes of patients admitted with critical asthma syndrome (CAS) to ICUs in Australia and New Zealand (ANZ), and a large cohort of ICUs in the United States (US). Methods: We examined two large databases of ICU for patients admitted with CAS in 2014 and 2015. We obtained, analyzed, and compared information on demographic and physiological characteristics, use of invasive mechanical ventilation, and clinical outcome and derived predictive models. Results: Overall, 2202 and 762 patients were admitted with a primary diagnosis of CAS in the ANZ and US databases respectively (0.73% vs. 0.46% of all ICU admissions, P < 0.001). A similar percentage of patients received invasive mechanical ventilation in the first 24 h (24.7% vs. 24.4%, P = 0.87) but ANZ patients had lower respiratory rates and higher PaCO2 levels. Overall mortality was low (1.23 for ANZ and 1.71 for USA; P = 0.36) and even among invasively ventilated patients (2.4% for ANZ vs. 1.1% for USA; P = 0.38). However, ANZ patients also had longer length of stay in ICU (43 vs. 37 h, P = 0.001) and hospital (105 vs. 78 h, P = 0.003). Conclusions: Patients admitted to ANZ and USA ICU with CAS are broadly similar and have a low and similar rate of invasive ventilation and mortality. However, ANZ patients made up a greater proportion of ICU patients and had longer ICU and hospital stays. These findings provide a modern invasive ventilation and mortality rates benchmark for future studies of CAS.
Collapse
Affiliation(s)
- Hussam Abdelkarim
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
| | - Matthew Durie
- Intensive Care Unit, Melbourne Health, Parkville, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia.,Intensive Care Unit, Melbourne Health, Parkville, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Medicine, University of Melbourne, Parkville, Melbourne, Australia
| | - Christoph Bergmeir
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Omar Badawi
- Department of eICU Research and Development, Philips Healthcare, Baltimore, Maryland, USA.,Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Khaled El-Khawas
- Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia
| | - David Pilcher
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
9
|
Boeschoten SA, Buysse CMP, Merkus PJFM, van Wijngaarden JMC, Heisterkamp SGJ, de Jongste JC, van Rosmalen J, Cochius-den Otter SCM, Boehmer ALM, de Hoog M. Children with severe acute asthma admitted to Dutch PICUs: A changing landscape. Pediatr Pulmonol 2018; 53:857-865. [PMID: 29635844 PMCID: PMC6032863 DOI: 10.1002/ppul.24009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/14/2018] [Indexed: 12/23/2022]
Abstract
UNLABELLED The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased. OBJECTIVES We investigated whether this trend in SAA PICU admissions is present in the Netherlands. METHODS A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality. RESULTS In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid-naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2-4 years [P = 0.026] and 5-17 years [P = 0.036]). CONCLUSIONS The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.
Collapse
Affiliation(s)
- Shelley A Boeschoten
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Corinne M P Buysse
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Peter J F M Merkus
- Department of Pediatrics, Division of Respiratory Medicine, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jacob M C van Wijngaarden
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Sabien G J Heisterkamp
- Department of Pediatric Intensive Care, Academic Medical Centre, Emma's Children Hospital, Amsterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Suzan C M Cochius-den Otter
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | | | - Matthijs de Hoog
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | | |
Collapse
|