THE OUTCOME OF PATIENTS WITH UPPER AIRWAY-OBSTRUCTION TRANSPORTED TO A REGIONAL PEDIATRIC INTENSIVE-CARE UNIT

The diagnoses, transfer, management and outcome of patients with upper airway obstruction (UAO) admitted from district general hospitals (DG H) to a regional paediatric intensive care unit were retrospectively r eviewed over a 3.5-year period. Sixty-seven patient episodes were anal ysed. Fifty-two cases (78%) underwent tracheal intubation prior to tra nsport with a low morbidity for both procedures. The most common diagn osis was viral croup (n = 34, 51%) with a median duration of intubatio n of 5 days, with subglottic stenosis being the next most common categ ory (n = 10, 15%), median duration of intubation 7 days. Inhaled budes onide was used prior to intubation in 12 (35%) of those with croup, an d inhaled bronchodilators in 28%, possibly reflecting diagnostic uncer tainty. Patients with croup treated with budesonide were significantly less likely to require intubation (P = 0.04). The re-intubation rate for patients with viral croup was uncomfortably high at 16% (4/25) des pite the routine use of prednisolone throughout the intubation period. Successful extubation of patients with viral croup could not be predi cted by age (P = 0.31), length of intubation (P = 0.94), endotracheal tube size, (P = 0.60) abnormalities on the chest X-ray (P = 1.0), or p resence of secondary bacterial infection (P = 0.23). Conclusion Althou gh viral croup remains the most common diagnostic category presenting at the DGH level with severe UAO, a wide range of other diagnoses is s een. Despite clear evidence of benefit, steroid administration to chil dren presenting at the DGH with viral croup has not become routine pra ctice. Once intubated, no reliable predictors of successful extubation were found amongst this patient group.