PURPOSE: This study was done to evaluate clinical course and outcomes of management of status asthmaticus in a tertiary care pediatric intensive care unit (PICU).
METHODS: The medical charts of all patients above 5 years of age admitted to the PICU with status asthmaticus, at Nationwide Children's hospital, Columbus, OH, between 2000-2007 were reviewed. Two hundred and forty seven (247) children were admitted on 281 occasions. Patients with significant co-morbidities were excluded. Final analysis was done using 222 encounters in 183 patients.
RESULTS: The mean age was 11 years (range, 5-20 years). The mean PICU stay was 2.1 days (range, 1-15 days) and mean hospital stay was 3.6 days. Male: Female 109:74. Among 222 encounters, 203 (91%) received continuous albuterol for mean duration of 1.3 days (range 1-6 days), 216 received i/v steroids every 6 hourly for mean of 2 days (range 1-6 days), 113 (51%) receive Turbutaline for mean duration of 1.34 days (range 1-6 days), 57 (26%) patients received MgSo4 of which 43 received only one dose. Eight patients received non-invasive ventilation (CPAP/BiPAP) for mean duration of one day (range 0.5 -2 days), Two patients received Heliox with duration of less then one day, Sixteen patients received mechanical ventilation for mean duration of 2 days (range 1-6 days). All patients survived and were transferred to the floors. At admission to PICU, initial CBG revealed mean pH of 7.33 (range 7.06 to 7.47) and mean paCO2 of 43 (range 22 to 109) which significantly improved to mean pH of 7.40 (range 7.28 to 7.51) and mean paCO2 of 34 (range 24 to 47). Initial vital signs revealed mean respiratory rate of 36 (range 10 to 76) which improved to 26 (range 16 to 47). Sixty two patients were still receiving supplemental oxygen when they were transferred from PICU to floor. Complications included bronchopneumonia in 25 cases, atelectasis in 29 cases and air leak in 4 patients and were resolved in all. None of the patients with air leak received non-invasive ventilation. Two patients developed chest pains with ST depression and both were receiving continuous albuterol and Turbutaline and symptoms resolved in both.
CONCLUSIONS: Current PICU management of childhood status asthmaticus is safe and outcomes are favorable. Patients receiving non-invasive ventilation improved without complications.
CLINICAL IMPLICATIONS: Outcome of PICU management of childhood status asthmaticus is favorable and use of curent therapies including non-invasive ventilation (CPAP/BiPAP) is safe.
DISCLOSURE: The following authors have nothing to disclose: Shahid Sheikh, Nadeem Khan, Melissa Frasure, Manual Cestari, Karen McCoy
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