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Clinical management practices of life-threatening asthma: an audit of practices in intensive care
Paul Secombe1, Penny Stewart2, Sunil Singh3
1Alice Springs Hospital, Alice Springs, NT, Australia. r.boots@uq.edu.au.
Objective:
Lack of management guidelines for lifethreatening asthma (LTA) risks practice variation. This study aims to elucidate management practices of LTA in the intensive care unit (ICU).
Design:
A retrospective cohort study.
Setting:
Thirteen participating ICUs in Australia between July 2010 and June 2013.
Participants:
Patients with the principal diagnosis of LTA.
Main Outcome Measures:
Clinical history, ICU management, patient outcomes, ward education and discharge plans.
Results:
Of the 270 (267 patients) ICU admissions, 69% were female, with a median age of 39 years (interquartile range [IQR], 26-53 years); 119 (44%) were current smokers; 89 patients (33%) previously required ICU admission, of whom 23 (25%) were intubated. The median ICU stay was 2 days (IQR, 2-4 days). Three patients (1%) died. Seventy-nine patients (29%) received non-invasive ventilation, with 11 (14%) needing subsequent invasive ventilation. Sixty-eight patients (25%) were intubated, with the majority of patients receiving volume cycled synchronised intermittent mechanical ventilation (n = 63; 93%). Drugs used included ß2-agonist by intravenous infusion (n = 69; 26%), inhaled adrenaline (n = 15; 6%) or an adrenaline intravenous infusion (n = 23; 9%), inhaled anticholinergics (n = 238; 90%), systemic corticosteroids (n = 232; 88%), antibiotics (n = 126; 48%) and antivirals (n = 22; 8%). When suitable, 105 patients (n = 200; 53%) had an asthma management plan and 122 (n = 202; 60%) had asthma education upon hospital discharge. Myopathy was associated with hyperglycaemia requiring treatment (odds ratio [OR], 31.6; 95% CI, 2.1-474). Asthma education was more common under specialist thoracic medicine care (OR, 3.0; 95% CI, 1.61-5.54).
Conclusion:
In LTA, practice variation is common, with opportunities to improve discharge management plans and asthma education.
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