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Critical Care Interventions for Asthmatic Patients Admitted From the Emergency Department to the Pediatric Intensive
Kristen Michelle Cundiff1, James M Gerard, Robert G Flood
1From the Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, Saint Louis, MO.
Insights
Pediatric patients with severe asthma (status asthmaticus) rarely need critical interventions in the pediatric intensive care unit (PICU) if they haven't received them in the emergency department (ED). A low clinical asthma score (CAS) suggests safe management outside the PICU.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Pulmonology
- Emergency Medicine
Background:
- Status asthmaticus is a severe form of asthma requiring intensive management.
- Pediatric intensive care unit (PICU) admissions for status asthmaticus necessitate understanding the need for critical interventions.
Purpose of the Study:
- To determine the frequency of critical interventions in pediatric patients with status asthmaticus admitted to the PICU.
- To identify predictors associated with requiring critical interventions in this patient population.
Main Methods:
- Retrospective chart review of 384 patients admitted to the PICU for status asthmaticus from January 2008 to March 2013.
- Exclusion of patients with comorbidities or prior critical interventions in the emergency department (ED).
- Data collection included demographics, clinical asthma scores (CAS), and hospital course.
Main Results:
- Only 8.9% of patients received critical interventions in the PICU.
- No patients required intubation, central venous catheter placement, circulatory collapse, or pneumothorax.
- Predictors for critical interventions included age >8 years, prior PICU admission, altered mental status, and high CAS on ED or PICU admission.
Conclusions:
- Critical interventions are infrequent in PICU-admitted status asthmaticus patients if not initiated in the ED.
- Patients with a CAS <5 may be safely managed in non-critical care units with continuous aerosolized albuterol.
Objectives:
The aim of this study was to assess the frequency and predictors of critical interventions in asthmatic patients admitted to the pediatric intensive care unit (PICU) at a tertiary-care pediatric hospital.
Methods:
We conducted a retrospective chart review of patients admitted from our emergency department (ED) to the PICU for treatment of status asthmaticus between January 1, 2008, and March 31, 2013. Patients with concomitant medical conditions and those who received a critical intervention, other than continuously aerosolized albuterol, in the ED before admission were excluded. Data collected included patient demographics, clinical characteristics including clinical asthma scores (CASs), hospital course, and adverse events.
Results:
A total of 384 patients were included in the analyses (mean age, 8.2 ± 4.5 years). Thirty-four patients (8.9%) received at least 1 critical intervention. No patients were intubated, had central venous catheter placement, and developed circulatory collapse or pneumothoraxes. Independent predictors associated with an increased likelihood of receiving a critical intervention included age above 8 years (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.9-9.4), previous PICU admission (OR, 3.2; 95% CI, 1.5-6.6), altered mental status on ED arrival (OR, 4.5; 95% CI, 1.5-13.4), CAS on ED arrival of 5 or greater (OR, 3.4; 95% CI, 1.3-9.1), and CAS on PICU admission of 5 or greater (OR, 4.3; 95% CI, 1.8-10.2).
Conclusions:
Patients admitted to the PICU for status asthmaticus infrequently require critical interventions if they have not been initiated in the ED. Patients with a CAS of less than 5 may be safely managed with continuously aerosolized albuterol on non-critical care units with low risk for clinical deterioration.
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