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Regional variation in ICU care for pediatric patients with asthma

Susan L Bratton1, Folafoluwa O Odetola, Jamie McCollegan

  • 1University of Utah School of Medicine, Department of Pediatrics, Salt Lake City, Utah, USA. susan.bratton@hsc.utah.edu

The Journal of Pediatrics
|September 27, 2005
PubMed

Insights

Adherence to severe asthma guidelines is low in pediatric intensive care units (PICUs). Regional variations in therapy use, particularly invasive ventilation, highlight a need for clearer clinical guidelines for pediatric asthma management.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Medicine
  • Clinical Practice Guidelines

Background:

  • Severe asthma management in pediatric intensive care units (PICUs) requires adherence to established clinical guidelines.
  • Variability in treatment practices can impact patient outcomes and resource utilization.

Purpose of the Study:

  • To assess adherence to severe asthma care guidelines in PICUs.
  • To investigate regional differences in the application of asthma therapies among critically ill children.

Main Methods:

  • Retrospective cohort study utilizing the Pediatric Health Information System (PHIS) database.
  • Analysis of 7125 children treated for asthma in PICUs between 2000 and 2003.
  • Evaluation of the use of specific asthma therapies beyond standard treatments.

Main Results:

  • Only 59% of children received inhaled anticholinergic medications, indicating low guideline adherence.
  • Significant regional variations were observed in the use of therapies like systemic beta-agonists, magnesium sulfate, heliox, and mechanical ventilation.
  • Over half of intubated patients (524/1024) required ventilation for 1 day or less, with significant regional variation in short-term ventilation use.

Conclusions:

  • Adherence to national guidelines for inhaled anticholinergic use in critically ill children with asthma is suboptimal.
  • There is considerable regional variability in the utilization of invasive ventilation for severe asthma.
  • Development of more explicit guidelines for invasive ventilation indications is recommended to enhance pediatric asthma care.
Abstract

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