PURPOSE:Patients with Asthma are at risk for acute decompensation and MICU admissions. An estimated 4 to 7 % of patients with Status Asthma (SA) are managed in MICU and about 30% of these patients need ventilatory support. The role of illicit substance abuse and Obesity on mortality and duration of mechanical ventilation (MV) is debatable. We report the outcomes of mechanically ventilated patients with SA and analysis of illict drug use and obesity subgroups.
METHODS:This is a retrospective study of all mechanically ventilated patients in SA admitted to a single center, closed inner city MICU with 24/7 intensivist coverage from January 2005 to December 2007. Demographic data, admission pCO2 levels, admission pH, weight, Urine toxicology, MV days and outcomes were collected by an independent observer.
RESULTS:156 mechanically ventilated patients with SA were admitted to the MICU during this period with mean APACHE II score of 10.8. Of these 146 were successfully extubated and there were 9 accidental extubations. Mean duration of mechanical ventilation was 2.57 (Table 1). Mortality was 0.6%.Sub group analysis of patients ( Table 2) with illicit drug use (Cocaine/opiates) when compared to others in SA showed no increase in mortality or duration of MV (p = 0.26). The findings were similar in the obesity Sub group (p = 0.23, Table 3) Logistic regression analysis of patients with illicit drug use and Obesity with age, gender, APACHE scores, admission pCO2 levels, abnormal Chest X ray findings, and MV days showed no correlation with any of the above variables.
CONCLUSION:Mortality of patients with SA needing Mechanical ventilation is low with favorable outcomes. Obesity or Illicit drug use does not increase days on mechanical ventilation or contribute to mortality. The limitations include findings in a single center closed ICU. To the best of out knowledge this is the largest case series of SA needing Mechanical ventilation.
CLINICAL IMPLICATIONS:Illicit substance use and Obesity are not independent risk factors for mortality or duration of mechanical ventilation in SA.
DISCLOSURE:Cesar Lopez, No Financial Disclosure Information; No Product/Research Disclosure Information