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Mechanical ventilation of paediatric patients with asthma: short and long term outcome
Insights
Severe pediatric asthma requiring intensive care is rare but impactful. Mechanical ventilation for acute asthma in children can lead to complications and long-term persistent asthma, affecting families significantly.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Asthma Research
Background:
- Acute asthma is a common pediatric respiratory illness.
- Intensive care unit (ICU) admission for severe asthma is infrequent but critical.
- Mechanical ventilation is a life-saving intervention for respiratory failure.
Purpose of the Study:
- To analyze the incidence and outcomes of pediatric asthma patients requiring mechanical ventilation.
- To identify complications associated with mechanical ventilation in severe asthma.
- To assess the long-term impact on survivors and their families.
Main Methods:
- Retrospective review of 10,639 pediatric asthma admissions over 7 years (1982-1988).
- Analysis of patients admitted to the Intensive Care Unit (ICU).
- Detailed examination of cases requiring mechanical ventilation, including complications and follow-up data.
Main Results:
- 2% of pediatric asthma admissions required ICU care; 0.3% needed mechanical ventilation.
- Five deaths occurred, primarily due to respiratory arrest before intubation.
- Complications included barotrauma (20%) and reversible myopathy.
- 78% of survivors developed persistent asthma, requiring readmission.
Conclusions:
- Mechanical ventilation for pediatric asthma, though uncommon, carries significant risks and complications.
- Asthma patients requiring ventilation often experience persistent disease post-ICU.
- Ventilation profoundly impacts family understanding and future asthma management.
Abstract:
In the 7 years from 1982 to 1988, 10,639 children with acute asthma were admitted to the Royal Children's Hospital, Melbourne. Of these, 262 children (2%) were treated in the Intensive Care Unit. Twenty-seven required mechanical ventilation on 34 occasions, being 0.3% of hospital asthma admissions. Five patients died, four due to brain death following respiratory arrest prior to intubation. The main complications were (i) barotrauma, which occurred in five patients on seven occasions (20%); (ii) a reversible myopathy which occurred in three patients treated with high dose corticosteroids and muscle relaxants. Follow-up of patients ventilated in intensive care revealed that all but one of the initial survivors was alive 1-5 years later, all patients required subsequent readmission to hospital for treatment of acute asthma and 78% had persistent rather than episodic asthma. Although uncommon, an episode of ventilation has a major impact on the family's understanding and future management of acute asthma.