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Respiratory failure from asthma. A marker for children with high morbidity and mortality
1Department of Pediatrics, University of Chicago Pritzker School of Medicine.
Insights
Children with severe asthma experiencing respiratory failure face high risks of repeat episodes and serious complications. Early identification and focused care are crucial for this high-risk pediatric asthma group.
Area of Science:
- Pediatric Pulmonology
- Asthma Research
- Critical Care Medicine
Background:
- Asthma is a common chronic respiratory disease in children.
- Respiratory failure in pediatric asthma patients is a serious complication.
- Previous studies have not fully characterized the long-term risks for children experiencing respiratory failure.
Purpose of the Study:
- To identify the risk of recurrent respiratory failure in children with a history of asthma-induced respiratory failure.
- To assess the long-term complications, including mortality and neurological damage, in this high-risk pediatric asthma population.
- To inform clinical and research strategies for managing severe pediatric asthma.
Main Methods:
- Retrospective cohort study over a seven-year period.
- Inclusion criteria: children with documented asthma-related respiratory failure (hypoxemia, hypercapnia, mechanical ventilation, or intravenous isoproterenol).
- Follow-up data collected on subsequent respiratory failure episodes, complications, and outcomes.
Main Results:
- 78 children experienced asthma-related respiratory failure over seven years.
- These children had a high rate of recurrent episodes (2.9 per patient), with 68% experiencing two or more.
- Compared to children without prior respiratory failure, this group had a significantly higher risk of death and hypoxic brain damage.
Conclusions:
- Children with even one episode of asthma-induced respiratory failure represent a distinct high-risk group.
- These patients are prone to repeated respiratory failure and severe adverse outcomes.
- Specialized clinical and research attention is warranted for this vulnerable pediatric asthma population.
Abstract:
During a seven-year interval, 78 children had documented episodes of respiratory failure from asthma, defined as arterial hypoxemia, hypercapnia, or use of mechanical ventilatory support or intravenous isoproterenol hydrochloride. During 407 patient-years of follow-up (5.2 years per patient), these 78 children had 227 episodes of respiratory failure (2.9 episodes per patient). Fifty-three patients (68%) have had two or more of such episodes. Second episodes usually followed the initial episodes within two years, but some were delayed for over six years. Seven of the 78 children died, and two others have incurred hypoxic brain damage, compared with two deaths among 2892 children with asthma--seen at this hospital during that interval--but without a documented previous episode of respiratory failure. We conclude that children whose asthma has caused even one episode of respiratory failure constitute a special group of asthmatic patients, members of which are at high risk for repeated episodes of respiratory failure and its catastrophic complications. This recognition allows special attention to be focused on them in designing both clinical and research strategies.