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Long term outcome of ventilated asthmatics
1Respiratory Unit, Alder Hey Children's Hospital, Liverpool.
Insights
Severe asthma attacks requiring mechanical ventilation (intermittent positive pressure ventilation/IPPV) in children are concerning. Survivors face ongoing asthma symptoms and a high risk of future mortality.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Acute severe asthma necessitates mechanical ventilation in a subset of pediatric patients.
- Intermittent positive pressure ventilation (IPPV) is employed for acute asthma exacerbations.
Purpose of the Study:
- To assess the long-term outcomes and mortality associated with IPPV in children with acute severe asthma.
Main Methods:
- Retrospective analysis of 48 IPPV episodes in 31 asthmatic children over 25 years (1971-1989).
- Follow-up assessments included symptom evaluation, pulmonary function tests (PFTs), and histamine challenge (PC20).
Main Results:
- Eight deaths occurred during IPPV; three additional deaths occurred post-discharge.
- Of 17 children followed up long-term, 16 experienced persistent asthma symptoms, with over half reporting daily symptoms.
- Pulmonary function tests showed reduced FEV1 (83% predicted) and airway hyperresponsiveness (geometric mean PC20 2.1 mg/ml).
Conclusions:
- IPPV is still required for a small number of children with severe asthma annually.
- Children requiring IPPV for asthma represent a high-risk group with significant long-term morbidity and mortality.
Abstract:
Over a 25 year period, 31 asthmatic children received artificial ventilation for acute asthma at Alder Hey Children's Hospital on 48 occasions. Altogether 47 episodes occurred from 1971-89, with no decline in the number of episodes per year (mean 2.5) over this period. Eight children died during intermittent positive pressure ventilation (IPPV), and of the 23 survivors, three further children had subsequently died from asthma. Seventeen children were followed up for more than a year after IPPV. Sixteen still had symptoms of asthma and over half had symptoms every day. Ten cooperated with pulmonary function tests: mean forced expiratory volume in one second was 83% of predicted and geometric mean provocative histamine concentration (PC20) was 2.1 mg/ml. Since the follow up study a fourth patient had died from asthma. IPPV continues to be required for a small number of asthmatic children each year. The survivors remain a high risk group with significant continuing morbidity and mortality.