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Practice Patterns for Acute Asthma Exacerbation in Adult Patients Admitted to U.S. Intensive Care Units
Collin Homer-Bouthiette1, Burton H Shen1, Aaron C Dobie1
1Pulmonary Center, Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts.
Annals of the American Thoracic Society
|June 27, 2024
Summary
Adjunct treatments for severe asthma exacerbations vary widely in US intensive care units (ICUs). Hospitals favoring noninvasive ventilation showed better patient outcomes than those favoring invasive ventilation.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Health Services Research
Background:
- Severe asthma exacerbations necessitate intensive care unit (ICU) admission, with guidelines recommending systemic corticosteroids and inhaled beta-agonists.
- The role and effectiveness of additional treatments beyond first-line therapies in ICUs remain unclear.
- Understanding practice variations in adjunct interventions is crucial for improving patient care.
Purpose of the Study:
- To investigate the patterns of adjunct intervention use in US ICUs for severe asthma exacerbations.
- To analyze the association between these adjunct interventions and patient outcomes.
- To identify hospital practice clusters based on intervention profiles.
Main Methods:
- Utilized the PINC AI Healthcare Database (2016-2022) for a multicenter study.
- Included adult patients admitted to US ICUs for acute asthma exacerbations.
- Employed hierarchical generalized linear models and K-means clustering to analyze intervention use, variation, and associations with outcomes.
Main Results:
- Identified 62,392 patients from 961 hospitals; significant between-hospital variation observed in heliox, inhaled steroids, and mechanical ventilation strategies.
- Two distinct hospital clusters emerged: one favoring noninvasive ventilation (NIV) and the other invasive mechanical ventilation (IMV).
- Hospitals in the NIV-predominant cluster (Cluster 1) showed better outcomes, including more hospital-free days and lower in-hospital mortality, compared to the IMV-predominant cluster (Cluster 2).
Conclusions:
- Adjunct intervention use for severe asthma exacerbations is highly variable across US hospitals, clustering around NIV or IMV strategies.
- A practice pattern favoring noninvasive ventilation is associated with improved patient outcomes.
- Findings can inform comparative effectiveness studies and standardization efforts in severe asthma management.
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