PURPOSE: Status asthmaticus is one of the most common causes of respiratory distress and critical illness in children. However, the utility of blood gas measurements in the management of these children has not been previously assessed. We conducted a review to determine the relative importance of blood gas measurement on clinical decision-making in this population.
METHODS: A retrospective chart review was conducted of all children admitted with status asthmaticus between March 2004 and March 2007. Clinical characteristics at the time of blood gas measurement and subsequent changes in therapy were recorded.
RESULTS: During the study period, 70% (88 of 125) of children admitted had at least one blood gas measurement obtained during their hospitalization. In these 88 children, 147 samples were obtained. The majority (79%) were venous. Measurement of a blood gas was not associated with baseline severity of illness or acute severity of illness on admission to the ICU as quantified by modified pulmonary index score (MPIS). Respiratory acidosis was uncommon (10%). Blood gases that were followed by a change in therapy (n=116, 89%) were associated with a higher respiratory rate (45 ± 11 vs 39 ± 12; p=0.02), higher MPIS at the time of the blood gas (14 ± 2 vs. 12 ± 3; p<0.001), and higher pCO2 (40 ± 11 vs. 36 ± 7; p<0.01) compared to blood gases that were not followed by a change in therapy. Respiratory acidosis, altered mental status, and pH were not associated with a change in therapy.
CONCLUSION: Blood gases were commonly performed on children admitted to the ICU with status asthmaticus. Respiratory acidosis was uncommon and although pCO2 was statistically elevated prior to a change in treatment, clinically this difference was insignificant. Clinical decision-making was dependent on a combination of factors in children with status asthmaticus, and not necessarily related to blood gas findings.
CLINICAL IMPLICATIONS: Blood gas measurements in this population did not dictate therapy independently and may not be indicated absent clinical concerns.
DISCLOSURE: Christopher Carroll, No Financial Disclosure Information; No Product/Research Disclosure Information