Fatal and Near-Fatal Asthma in Children: The Critical Care Perspective

The Journal of Pediatrics, 05/03/2012

Newth CJL et al. – Of the children ventilated in the Collaborative Pediatric Critical Care Research Network (CPCCRN) pediatric intensive care units (PICUs), 96% survived to hospital discharge. Most of the children who died experienced cardiac arrest before admission. Intubation outside the PICU was correlated with shorter duration of ventilation. Complications of barotrauma and neuromyopathy were uncommon. Practice patterns varied widely among the CPCCRN sites.

Methods

  • This was a retrospective chart abstraction across the 8 tertiary care PICUs of the Collaborative Pediatric Critical Care Research Network (CPCCRN).
  • Inclusion criteria were children (aged 1-18 years) admitted between 2005 and 2009 (inclusive) for asthma who received ventilation (near-fatal) or died (fatal).
  • Data collected included medications, ventilator strategies, concomitant therapies, demographic information, and risk variables.

Results

  • Of the 261 eligible children, 33 (13%) had no previous history of asthma, 218 (84%) survived with no known complications, and 32 (12%) had complications.
  • Eleven (4%) died, 10 of whom had experienced cardiac arrest before admission.
  • Patients intubated outside the PICU had a shorter duration of ventilation (median, 25 hours vs 84 hours; P < .001).
  • African-Americans were disproportionately represented among the intubated children and had a shorter duration of intubation.
  • Barotrauma occurred in 15 children (6%) before admission.
  • Pharmacologic therapy was highly variable, with similar outcomes.

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