Clinical course and outcome of patients admitted to an ICU for status asthmaticus

Study objectives: To describe the prognostic factors, clinical course, and outcome of patients with status asthmaticus treated in a medical ICU (MICU) . Design: Analysis of prospective data. Setting: A multidisciplinary MICU of an inner-city university hospital. Pat ients: We collected data on 132 hospital admissions of 89 patients with sta tus asthmaticus treated in our MICU from August 1995 through July 1998. Measurements: APACHE (acute physiology and chronic health evaluation) II sc ores were among the parameters measured. Results: Seventy-nine percent of the patients were female, and 67% were Afr ican American (mean SD age, 42.4 +/- 15.1 years). Patients in 48 of the 132 hospital admissions (36%) required invasive mechanical ventilation; sepsis developed in patients during 17 hospital admissions (13%), nonpulmonary or gan failure developed during 16 hospital admissions (12%), and ARDS develop ed during 2 hospital admissions (2%). Pneumothorax developed in four patien ts and required tube thoracostomy in all four patients. The median APACHE I I score was 11. Predicted mortality and actual mortality were 6.7% and 8.3% , respectively. The two most common immediate causes of death were pneumoth orax (n = 3) and nosocomial infection (n = 3). All the deaths occurred in f emale patients. Compared with survivors, nonsurvivors had higher APACHE II scores (median, 26 vs 15; p < 0.0001), Paco(2) (63.8 +/- 21.3 mm Hg vs 47.8 +/- 19.1 mm Hg, p = 0.0101), and lower arterial pH (7.09 +/- 0.12 vs 7.27 +/- 0.12, p < 0.0001), respectively. Patients in 10 of 48 hospital admissio ns (21%) who required mechanical ventilation died. Conclusions: The hospital mortality of patients admitted to an MICU for sta tus asthmaticus is higher than expected. Higher APACHE II score and Paco(2) and lower arterial pH within 24 h of hospital admission are associated wit h increased mortality. Sepsis and nonpulmonary organ failure are more likel y to develop in nonsurvivors than survivors.