SEVERE ACUTE ASTHMA IN A COMMUNITY-HOSPITAL PEDIATRIC INTENSIVE-CARE UNIT - A 10 YEARS EXPERIENCE

Background: The clinical literature on the incidence and subsequent mo rtality of asthma has come primarily from the experiences of large ter tiary referral centers, particularly in Western Europe and North Ameri ca. Consequently, very little has been published on the incidence, man agement, and outcome of asthma in smaller, community-based intensive c are units. Objectives: The purpose of this study was to explore the co urse and outcome of children with acute severe asthma treated within a community hospital PICU compared with those described in the literatu re from larger tertiary referral centers. Design: A retrospective anal ysis of 49 asthmatic children admitted to the Pediatric Intensive Care Unit (PICU) over a 10-year period was performed. Measurements and res ults: The mean age was 5.2 years (range 2 months to 16 years), and the male:female ratio was 3:1. Duration of symptoms prior to admission to hospital was less than 24 hours in 60.4% of the patients. The majorit y of patients was not treated with either inhaled or oral steroids bef ore admission. Drugs used in the PICU included nebulized beta(2)-agoni sts, theophylline, steroids, intravenous salbutamol, and intravenous i soproterenol. Although a pharmacologic approach was successful in the majority of patients, intubation and mechanical ventilation were neces sary for progressive hypercapnea, exhaustion, and cardiorespiratory ar rest in 11/49 of these patients. The average stay in the ICU for our p atient group was 2.4 days. Intubated patients had a mean average stay of 3.5 days. Two patients had pneumothorax related to positive pressur e ventilation, requiring chest tube insertion for drainage. There were no deaths among the 49 patients admitted to our PICU. Conclusions: Th ese data show that for acute severe asthma, outcome is comparable in a community PICU to a tertiary referral institution. We conclude that e arly ICU admission along with close monitoring is important in reducin g morbidity and mortality in children with severe asthma.