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Children with severe acute asthma admitted to Dutch PICUs: A changing landscape
Shelley A Boeschoten1, Corinne M P Buysse1, Peter J F M Merkus2
1Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands.
Insights
Severe acute asthma (SAA) admissions to pediatric intensive care units (PICUs) in the Netherlands have tripled. This increase in SAA PICU admissions is linked to more steroid-naïve children and earlier IV salbutamol use.
Area of Science:
- Pediatric Intensive Care Medicine
- Respiratory Medicine
- Epidemiology
Background:
- Global trends indicate an rise in pediatric intensive care unit (PICU) admissions for severe acute asthma (SAA).
- Understanding regional trends is crucial for resource allocation and treatment protocol development.
Purpose of the Study:
- To determine if the Netherlands has experienced an increase in SAA PICU admissions.
- To analyze trends in SAA severity, treatment, and patient demographics over an 11-year period.
Main Methods:
- A multicenter retrospective cohort study was conducted across all tertiary care PICUs in the Netherlands.
- Data from 590 children (660 admissions) aged 2-18 years hospitalized for SAA between 2003 and 2013 were analyzed.
- Included data encompassed demographics, asthma diagnosis, treatment modalities, and mortality rates.
Main Results:
- A threefold increase in annual SAA PICU admissions was observed over the 11-year study period.
- Despite increased admissions, SAA severity (based on blood gas, length of stay, mortality) remained unchanged.
- Key changes included increased use of high-flow nasal cannula, decreased need for invasive ventilation, and a rise in steroid-naïve patients.
Conclusions:
- The number of pediatric intensive care unit admissions for severe acute asthma in the Netherlands has significantly increased.
- This rise is potentially attributed to a growing population of steroid-naïve children and a lower threshold for PICU admission, possibly due to earlier intravenous salbutamol administration in referring hospitals.
Abstract:
The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased.
Objectives:
We investigated whether this trend in SAA PICU admissions is present in the Netherlands.
Methods:
A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality.
Results:
In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid-naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2-4 years [P = 0.026] and 5-17 years [P = 0.036]).
Conclusions:
The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.
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