PURPOSE: Status asthmaticus is the most common cause for admission to a pediatric ICU. Children requiring mechanical ventilation for asthma are at increased risk for complications as a result of this therapy. Our hypothesis was that children experiencing a complication would have an increased duration of hospitalization for status asthmaticus.
METHODS: We retrospectively examined data from all children older than two years of age who were intubated and mechanically ventilated for status asthmaticus between April 1997 and April 2006.
RESULTS: Thirty four (13%) of the 271 children admitted to the ICU with status asthmaticus were endotracheally intubated and mechanically ventilated. The mean age was 10.0 + 4.8 years, and 58% were male. Fourteen of these children (41%) experienced one or more complications during their hospitalization. The most common complications were aspiration or ventilator-associated pneumonia (44%), pneumothorax or pneumomediastinum (28%), rhabdomyolysis (11%), and endotracheal tube displacement (11%). Children experiencing a complication had significantly longer duration of mechanical ventilation (156 + 172 hours vs. 66 + 66 hours, p<0.05), ICU length of stay (228 + 184 hours vs. 120 + 86 hours, p=0.02) and hospital charges ($105,663 + 105,690 vs. $37,075 + 27,345; p=0.009) than children who did not. There was no difference in admission asthma severity score (Modified Pulmonary Index Score) or in baseline asthma severity (NIH asthma classification) between those who experienced a complication and those who did not.
CONCLUSION: Complications during mechanical ventilation for pediatric status asthmaticus are associated with significantly increased duration of mechanical ventilation, ICU length of stay, and hospital charges.
CLINICAL IMPLICATIONS: Intubation for status asthmaticus can be associated with significant morbidity in the pediatric population. This identifies an important area of study for quality improvement efforts in the Pediatric ICU.
DISCLOSURE: Christopher Carroll, None.