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Dexamethasone for Pediatric Critical Asthma: A Multicenter Descriptive Study
Austin R Sellers1, Meghan R Roddy2, Kristina K Darville3
1Institute for Clinical and Translational Research, 7582Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Journal of Intensive Care Medicine
|March 3, 2022
Summary
Dexamethasone prescribing is increasing for pediatric critical asthma, showing reduced severity and fewer adverse events compared to methylprednisolone. Further research is needed to determine optimal corticosteroid regimens.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Systemic corticosteroids are crucial for managing severe pediatric asthma.
- Intravenous methylprednisolone is common, but dexamethasone is emerging as an alternative.
- This study examines corticosteroid prescribing trends in pediatric intensive care units.
Purpose of the Study:
- To assess trends and variations in corticosteroid prescribing for critical asthma in children.
- To compare outcomes associated with different corticosteroid regimens.
Main Methods:
- Multicenter retrospective cohort study using the Pediatric Health Information System (PHIS) registry.
- Included children aged 3-17 years admitted for critical asthma from 2011-2019.
- Analyzed corticosteroid prescribing rates, adverse events, interventions, mortality, and length of stay.
Main Results:
- Dexamethasone prescribing increased by 0.5% annually, with dexamethasone-alone use at 2.4%.
- Dexamethasone-alone was associated with reduced asthma severity, shorter hospital stays, and fewer adjunctive treatments.
- Adverse events like gastritis and hyperglycemia were less frequent with dexamethasone-alone.
Conclusions:
- Dexamethasone prescribing is rising for pediatric critical asthma.
- Variability in prescribing suggests a need for prospective studies to establish ideal corticosteroid regimens.
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