Mechanical ventilation in children with severe asthma

Hospital admissions for childhood asthma have increased during the past few decades. The aim of this study was to describe the need for mechanical ven tilation for severe asthma exacerbation in children in Finland from 1976 to 1995. We reviewed medical records and collected data retrospectively from all 5 university hospitals in Finland, thus covering the entire population of about 5 million. The endpoints selected were the number of admissions an d readmissions leading to mechanical ventilation, duration of stay in the h ospital, and mortality. Moreover, asthma medications prescribed prior to ad mission and administered in the intensive care unit (ICU), as well as the e tiology of the exacerbation associated with mechanical Ventilation were exa mined. Mechanical ventilation was required in 66 ICU admissions (59 patients). Thi s constituted approximately 10% of all 632 admissions for acute asthma to a n ICU. The number of admissions decreased from 1976 to 1995: 41 admissions between 1976 and 1985 vs. 25 admissions during the next 10-year period. The mean age at admission to the ICU was 3.6 years, and 46% of the patients we re boys. Prior to the index admission, 70% of the patients had used asthma medication such as oral bronchodilator (50%), inhaled bronchodilator (20%), theophylline (38%), inhaled glucocorticoid (18%), oral glucocorticoid (5%) , and cromoglycate (7%). Respiratory infection was by far the most common c ause of all the exacerbations (61%), followed by food allergy (8%) and gast roesophageal reflux (3%). In 28% of cases the cause of the severe asthma ex acerbation could not be identified. In the mechanically ventilated patients readmissions occurred 38 times between 1976 and 1985 vs. 5 times between 1 986 and 1995. Five of the patients who received mechanical ventilation died , and in 3 of these patients asthma was the event causing death. In conclusion, there has been decrease in the number of first and repeat IC U admission for asthma requiring mechanical Ventilation between 1970 and 19 95. This trend occurred despite a simultaneous 5% yearly increase in hospit al admissions for childhood asthma during these 2 decades. (C) 2001 Wiley-L iss, Inc.