TY - JOUR
T1 - Fatal and near-fatal asthma in children
T2 - The critical care perspective
AU - Newth, Christopher J.L.
AU - Meert, Kathleen L.
AU - Clark, Amy E.
AU - Moler, Frank W.
AU - Zuppa, Athena F.
AU - Berg, Robert A.
AU - Pollack, Murray M.
AU - Sward, Katherine A.
AU - Berger, John T.
AU - Wessel, David L.
AU - Harrison, Rick E.
AU - Reardon, Jean
AU - Carcillo, Joseph A.
AU - Shanley, Thomas P.
AU - Holubkov, Richard
AU - Dean, J. Michael
AU - Doctor, Allan
AU - Nicholson, Carol E.
N1 - Funding Information:
Supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (cooperative agreements U10-HD050012, U10-HD050096, U10-HD063108, U10-HD049983, U10-HD049981, U10-HD063114, and U10-HD063106 ), the Obstetric and Pediatric Pharmacology Branch , and the Best Pharmaceuticals for Children Act . The authors declare no conflicts of interest.
PY - 2012/8
Y1 - 2012/8
N2 - Objective: To characterize the clinical course, therapies, and outcomes of children with fatal and near-fatal asthma admitted to pediatric intensive care units (PICUs). Study design: This was a retrospective chart abstraction across the 8 tertiary care PICUs of the Collaborative Pediatric Critical Care Research Network (CPCCRN). Inclusion criteria were children (aged 1-18 years) admitted between 2005 and 2009 (inclusive) for asthma who received ventilation (near-fatal) or died (fatal). Data collected included medications, ventilator strategies, concomitant therapies, demographic information, and risk variables. Results: Of the 261 eligible children, 33 (13%) had no previous history of asthma, 218 (84%) survived with no known complications, and 32 (12%) had complications. Eleven (4%) died, 10 of whom had experienced cardiac arrest before admission. Patients intubated outside the PICU had a shorter duration of ventilation (median, 25 hours vs 84 hours; P <.001). African-Americans were disproportionately represented among the intubated children and had a shorter duration of intubation. Barotrauma occurred in 15 children (6%) before admission. Pharmacologic therapy was highly variable, with similar outcomes. Conclusion: Of the children ventilated in the CPCCRN PICUs, 96% survived to hospital discharge. Most of the children who died experienced cardiac arrest before admission. Intubation outside the PICU was correlated with shorter duration of ventilation. Complications of barotrauma and neuromyopathy were uncommon. Practice patterns varied widely among the CPCCRN sites.
AB - Objective: To characterize the clinical course, therapies, and outcomes of children with fatal and near-fatal asthma admitted to pediatric intensive care units (PICUs). Study design: This was a retrospective chart abstraction across the 8 tertiary care PICUs of the Collaborative Pediatric Critical Care Research Network (CPCCRN). Inclusion criteria were children (aged 1-18 years) admitted between 2005 and 2009 (inclusive) for asthma who received ventilation (near-fatal) or died (fatal). Data collected included medications, ventilator strategies, concomitant therapies, demographic information, and risk variables. Results: Of the 261 eligible children, 33 (13%) had no previous history of asthma, 218 (84%) survived with no known complications, and 32 (12%) had complications. Eleven (4%) died, 10 of whom had experienced cardiac arrest before admission. Patients intubated outside the PICU had a shorter duration of ventilation (median, 25 hours vs 84 hours; P <.001). African-Americans were disproportionately represented among the intubated children and had a shorter duration of intubation. Barotrauma occurred in 15 children (6%) before admission. Pharmacologic therapy was highly variable, with similar outcomes. Conclusion: Of the children ventilated in the CPCCRN PICUs, 96% survived to hospital discharge. Most of the children who died experienced cardiac arrest before admission. Intubation outside the PICU was correlated with shorter duration of ventilation. Complications of barotrauma and neuromyopathy were uncommon. Practice patterns varied widely among the CPCCRN sites.
UR - http://www.scopus.com/inward/record.url?scp=84864282767&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2012.02.041
DO - 10.1016/j.jpeds.2012.02.041
M3 - Article
C2 - 22494876
AN - SCOPUS:84864282767
SN - 0022-3476
VL - 161
SP - 214-221.e3
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -