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Asthma exacerbation requiring ventilatory support in adults: a 10-year retrospective multicentre cohort study - the
Nina De Montmollin1, Arnaud W Thille2, Guillaume Carteaux3
1Médecine Intensive Réanimation, Hôpital Tenon, Paris, France nina.demontmollin@aphp.fr.
Background:
Little is known about the clinical outcomes of patients admitted to the intensive care unit (ICU) for severe asthma exacerbation requiring ventilatory support.
Research Question:
Our objectives were (i) to describe the initial presentation, therapeutic management and clinical outcomes of adults admitted to the ICU for asthma exacerbation requiring ventilatory support and (ii) to identify risk factors for a prolonged course and/or fatal outcome.
Study Design And Methods:
We conducted a 10-year multicentre (n=21) retrospective study in France. All adult patients with asthma admitted to the ICU for an exacerbation requiring invasive (IMV) and/or non-invasive (NIV) mechanical ventilation were included. The primary endpoint was 'complicated course', a composite criterion of death during the ICU stay and/or the need for IMV for ≥7 days.
Results:
From 2010 to 2019, 349 patients were included (women 57%, age 54 (40-65) years). Acute respiratory failure was the primary reason for ICU admission. However, 12% of patients were admitted following a cardiorespiratory arrest. Respiratory tract infections were documented in 36% of patients, with Haemophilus influenzae, Streptococcus pneumoniae and Rhinovirus as the predominant pathogens. Three-quarters of the patients required IMV, with a median duration of 5 (3-12) days. One-third underwent NIV as initial ventilatory support, but NIV failed in 23% of them. In-hospital mortality was 8%. The composite primary endpoint was observed in 34% of patients. Multivariable analysis identified Sepsis-related Organ Failure Assessment score, pH≤7.3 and a documented respiratory tract infection on ICU admission as independent risk factors for a complicated course.
Conclusions:
Exacerbation requiring ventilatory support was associated with a substantial burden in adult patients with asthma. Respiratory infection was the predominant suspected triggering factor. Respiratory tract infections were documented in 36% of patients and were independently associated with a prolonged course and/or fatal outcome in the ICU.
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