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Critical Care for Pediatric Asthma: Wide Care Variability and Challenges for Study #MMPMID22067984
Bratton SL; Newth CJL; Zuppa AF; Moler FW; Meert KL; Berg RA; Berger J; Wessel D; Pollack M; Harrison R; Carcillo JA; Shanley TP; Liu T; Holubkov R; Dean JM; Nicholson CE
Pediatr Crit Care Med 2012[Jul]; 13 (4): 407-14 PMID22067984show ga
Objective: To describe pediatric severe asthma care, complications and outcomes to plan for future prospective studies by the Collaborative Pediatric Critical Care Research Network (CPCCRN). Design: Retrospective cohort study. Setting: Pediatric intensive care units (PICU)s in the United States that submit administrative data to the Pediatric Health Information System (PHIS). Patients: Children 1-18 years treated in a PHIS PICU for asthma during 2004 to 2008. Interventions: None Measurement and Main Results: 13,552 children were studied; 2,812 (21%) treated in a CPCCRN and 10,740 (79%) in a non-CPCCRN PICU. Medication use in individual CPCCRN centers differed widely: ipratropium bromide (41-84%) terbutaline (11-74%), magnesium sulfate (23-64%) and methylxanthines (0-46%). Complications including pneumothorax (0-0.6%), cardiac arrest (0.2-2%) and aspiration (0.2-2%) were rare. Overall use of medical therapies and complications at CPCCRN centers were representative of pediatric asthma care at non-CPCCRN PICUs.Median length of PICU stay at CPCCRN centers was 1 to 2 days and death was rare (0.1-3%). Ten percent of children treated at CPCCRN centers received invasive mechanical ventilation compared to12 percent at non-CPCCRN centers. Overall 44% of patients who received invasive mechanical ventilation were intubated in the PICU. Children intubated outside the PICU had significantly shorter median ventilation days (1 vs.3), PICU days (2 vs. 4) and hospital days (4 vs. 7) compared to those intubated in the PICU. Among children who received mechanical respiratory support significantly more (41 vs. 25%) were treated with non-invasive ventilation and significantly fewer (41 vs. 58%) were intubated prior to PICU care when treated in a PHIS hospital emergency department. Conclusions: Marked variations in medication therapies and mechanical support exist. Death and other complications were rare. Over half of patients treated with mechanical ventilation were intubated prior to PICU care. Site of respiratory mechanical support initiation is associated with length of stay.
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Pediatr+Crit+Care+Med 2012 ; 13 (4): 407-14
