Italian Journal of Pediatrics

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Outcome of children with life-threatening asthma necessitating pediatric intensive care

Kam-Lun Hon1*, Wing-Sum W Tang2, Ting-Fan Leung1, Kam-Lau Cheung1 and Pak-Cheung Ng1

Author Affiliations

1 Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong

2 Department of Family Medicine, University at Buffalo, Erie County Medical Center, 462 Grider St. Buffalo NY, 14215 USA

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Italian Journal of Pediatrics 2010, 36:47 doi:10.1186/1824-7288-36-47

Published: 6 July 2010

Abstract

Objective

To report the outcome of children with life-threatening asthma (LTA) admitted to a university Pediatric Intensive Care Unit (PICU).

Methods

Retrospective study between October 2002 and May 2010 was carried out. Every child with LTA and bronchospasm was included.

Results

30 admissions of 28 patients (13 M, 17 F) were identified which accounted for 3% of total PICU admissions (n = 1033) over the study period. The majority of patients were toddlers (median age 3.1 years). Few had past history of prematurity, lung diseases, or neuro-developmental conditions. Approximately half had previous admissions for asthma and one-forth with history of non-compliance to recommended treatment for asthma. One patient had parainfluenza virus and one had rhinovirus isolated. None of these factors were associated with need for mechanical ventilation (n = 6 admissions). Comparing with patients who did not receive mechanical ventilation, ventilated children had significantly higher PIM2 score (1.65 versus 0.4, p < 0.001), higher PCO2 levels (9.3 kPa versus 5.1 kPa, p = 0.01) and longer PICU stay (median 2.5 days versus 2 days, p = 0.03) The majority of patients received systemic corticosteroids, intravenous or inhaled bronchodilators. There was one pneumothorax but no death in this series.

Conclusions

LTA accounted for a small percentage of PICU admissions. Previous hospital admissions for asthma and history of non-compliance were common. Approximately one quarters required ventilatory supports. Regardless of the need for mechanical ventilation, all patients survived with prompt treatment.