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Asthma changes at a pediatric intensive care unit after 10 years: Observational study
Ayman A Al-Eyadhy1, Mohamad-Hani Temsah1, Ali A N Alhaboob1
1Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Insights
Management of pediatric severe asthma has evolved, with increased Pediatric Intensive Care Unit (PICU) admissions and greater use of inhaled ipratropium bromide and non-invasive ventilation (NIV). This shift in treatment for acute severe asthma (ASA) occurred in a tertiary care setting.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Asthma management
Background:
- Acute severe asthma (ASA) in children requires intensive management.
- Previous treatment protocols and outcomes for pediatric ASA were established in 2003.
- Tertiary care centers play a crucial role in managing severe pediatric respiratory conditions.
Purpose of the Study:
- To compare the management and outcomes of pediatric patients with ASA admitted to the Pediatric Intensive Care Unit (PICU).
- To evaluate changes in treatment strategies for ASA over a decade (2003 vs. 2013).
- To assess the impact of evolving medical practices on pediatric ASA patient care.
Main Methods:
- Retrospective observational study design.
- Inclusion of all consecutive pediatric ASA patients admitted to the PICU.
- Comparison of a 2013 cohort with a previously published 2003 cohort from the same institution.
Main Results:
- The 2013 cohort showed a higher mean age and a significantly increased rate of PICU admissions compared to the 2003 cohort.
- Increased utilization of inhaled ipratropium bromide, intravenous magnesium sulfate, and non-invasive ventilation (NIV) in the 2013 cohort.
- Decreased use of maintenance inhaled steroids and theophylline, with no patients requiring intubation or experiencing mortality in the 2013 cohort.
Conclusions:
- Pediatric ASA management has shifted towards older children and increased PICU admission rates.
- The use of inhaled ipratropium bromide, magnesium sulfate, and NIV has become more prevalent in treating pediatric ASA.
- Current management strategies for pediatric ASA in tertiary care settings have led to favorable outcomes without mortality or intubation.
Objectives:
To describe the change in the management, and outcome of children with acute severe asthma (ASA) admitted to Pediatric Intensive Care Unit (PICU) at tertiary institute, as compared to previously published report in 2003.
Methods:
This is a retrospective observational study. All consecutive pediatric ASA patients who were admitted to PICU during the study period were included. The data were extracted from PICU database and medical records. The Cohort in this study (2013 Cohort) was compared with the Cohort of ASA, which was published in 2003 from the same institution (2003 Cohort).
Results:
In comparison to previous 2003 Cohort, current Cohort (2013) revealed higher mean age (5.5 vs. 3.6 years; P ≤ 0.001), higher rate of PICU admission (20.3% vs. 3.6%; P ≤ 0.007), less patients who received maintenance inhaled steroids (43.3% vs. 62.4%; P ≤ 0.03), less patients with pH <7.3 (17.9% vs. 42.9%; P ≤ 0.001). There were more patients in 2013 Cohort who received: Inhaled Ipratropium bromide (97% vs. 68%; P ≤ 0.001), intravenous magnesium sulfate (68.2% vs. none), intravenous salbutamol (13.6% vs. 3.6%; P ≤ 0.015), and noninvasive ventilation (NIV) (35.8% vs. none) while no patients were treated with theophylline (none vs. 62.5%). The median length of stay (LOS) was 2 days while mean LOS was half a day longer in the 2013 Cohort. None of our patients required intubation, and there was no mortality.
Conclusion:
We observed slight shift toward older age, considerably increased the rate of PICU admission, increased utilization of Ipratropium bromide, magnesium sulfate, and NIV as important modalities of treatment.
