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Published on: November 4, 2010
Outcomes following admission to intensive care for asthma
Rina Triasih1, Trevor Duke, Colin F Robertson
1Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Flemington Rd, Parkville, Victoria 3052, Australia. rina_triasih@yahoo.com
Insights
Children admitted to the intensive care unit (ICU) for severe asthma face long-term risks. Persistent asthma or requiring ventilation increases mortality risk, highlighting the need for close follow-up.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Epidemiology
Background:
- Severe asthma is a frequent reason for pediatric intensive care unit (ICU) admissions.
- Limited data exist on the long-term health outcomes for children with severe asthma requiring ICU care.
Purpose of the Study:
- To describe the long-term outcomes of children with asthma admitted to the ICU.
- To identify risk factors for readmission and mortality in this patient group.
Main Methods:
- A retrospective study of children aged 2-18 years with asthma admitted to the Royal Children's Hospital Melbourne's ICU between 1990 and 2004.
- Data collection involved medical record review and telephone interviews, with a mean follow-up of 10.3 years.
Main Results:
- Of 684 eligible patients, 410 had complete data. 67% were readmitted for asthma, 17% to the ICU. 88% continued to have asthma (46% episodic, 42% persistent). 1.8% died from asthma.
- Risk factors for ICU readmission included prior year asthma admission and ventilation. Risk factors for mortality included multiple ICU admissions, persistent asthma, and ventilation.
Conclusions:
- Pediatric ICU admission for asthma predicts future hospital readmissions.
- Children with persistent asthma or requiring ventilation are at increased risk of subsequent mortality and necessitate vigilant monitoring.
Objective:
Acute severe asthma in children is a common cause of admission to intensive care units (ICU), but there are few reports on long-term outcomes. This study describes outcomes for children with asthma admitted to an ICU.
Methods:
All children with asthma aged 2-18 years admitted to the ICU at the Royal Children's Hospital Melbourne between 1990 and 2004 were eligible for the study. Data were collected by reviewing medical records and through telephone interviews.
Results:
Complete data were obtained for 410 (61%) of 684 eligible patients. The mean duration of follow-up was 10.3±4.6 years. After the index admission, 67% were readmitted to hospital for asthma and 17% to the ICU. Eighty-eight per cent continued to have asthma: 46% had episodic asthma and 42% persistent asthma. Twelve patients (1.8%) subsequently died from asthma. Five per cent of those who required ventilation at their index admission died within 10 years. Risk factors for ICU readmission were admission for asthma in the preceding year (AOR 4.7; 95% CI 2.4 to 9.3) and ventilation at admission (AOR 2.4; 95% CI 1.0 to 5.3). Risk factors for subsequent mortality were multiple ICU admissions (AOR 5.0; 95% CI 1.3 to 19), persistent asthma (AOR 5.8; 95% CI 1.2 to 28.5) and ventilation at admission (AOR 4.5; 95% CI 1.3 to 15.7).
Conclusion:
Admission to the ICU for asthma is a predictor of hospital readmission. Those with persistent asthma or requiring ventilation are at significant risk of mortality in subsequent years and require close follow-up.
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