PURPOSE: Status asthmaticus (SA) is a common reason for PICU admission. The effect of obesity on asthma course is of increasing interest. However, few data evaluating the impact of obesity on ICU course (duration and/or intensity of therapy) exist for pediatric patients with SA.
METHODS: This retrospective review, approved by the University of Louisville IRB, included all patients with SA ≥1 yr admitted to our PICU between 09/2005 and 03/2007. Patients with chronic medical conditions were included. Basic demographic data, including BMI, were collected as was ICU course data, including LOS and intensity of treatment (drugs used, duration and cumulative doses). Obesity was defined as BMI ≥30 and overweight as BMI ≥25. The effects of demographic or treatment factors on ICU course were evaluated by linear regression or t-test as appropriate.
RESULTS: 343 patients (56% male) were identified. Mean age was 88± 59 mos. Most were Caucasian (54%) or African American (42%). Mean BMI was 21± 19 (range 9.2-68.4). Twenty (6.8%) were obese while 58 (16.9%) were overweight . Mean ICU LOS was 50± 51 hrs (1-408 hrs). Neither race, gender, nor BMI had a significant effect on ICU LOS although LOS did increase with increasing age (p=0.0065). Complete drug information was available for 142 patients. In this group, increasing BMI positively correlated with duration of continuous albuterol (p=0.01), but not duration of IV steroids. Fifty-seven patients (37%) received magnesium sulfate infusions, 26 (18%) received methylxanthines, and 22 received both. Mean BMI was greater in patients who received a magnesium infusion (22.3± 8.2 vs 18.8± 7.5; p=0.01), methylxanthines, (25.0± 9.9 vs 19± 0.7; p=0.0004), or both (25.6± 10.3 vs 18.8± 7.5, p=0.001).
CONCLUSION: Obesity did not affect ICU LOS but did impact intensity of therapy, including duration of continuous albuterol, and the need for escalation to other adjunct therapies.
CLINICAL IMPLICATIONS: It is possible that earlier, more aggressive therapy, during SA in obese children may positively impact the duration of their ICU course.
DISCLOSURE: John Berkenbosch, No Financial Disclosure Information; No Product/Research Disclosure Information