title: The outcome of patients with upper airway obstruction transported to a regional paediatric intensive care unit.
abstract: The diagnoses, transfer, management and outcome of patients with upper airway obstruction (UAO) admitted from district general hospitals (DGH) to a regional paediatric intensive care unit were retrospectively reviewed over a 3.5-year period. Sixty-seven patient episodes were analysed. Fifty-two cases (78%) underwent tracheal intubation prior to transport with a low morbidity for both procedures. The most common diagnosis was viral croup (n = 34, 51%) with a median duration of intubation of 5 days, with subglottic stenosis being the next most common category (n = 10, 15%), median duration of intubation 7 days. Inhaled budesonide was used prior to intubation in 12 (35%) of those with croup, and inhaled bronchodilators in 28%, possibly reflecting diagnostic uncertainty. 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) despite the routine use of prednisolone throughout the intubation period. Successful extubation of patients with viral croup could not be predicted 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 presence of secondary bacterial infection (P = 0.23).
  
  
  CONCLUSIONS
  Although viral croup remains the most common diagnostic category presenting at the DGH level with severe UAO, a wide range of other diagnoses is seen. Despite clear evidence of benefit, steroid administration to children presenting at the DGH with viral croup has not become routine practice. Once intubated, no reliable predictors of successful extubation were found amongst this patient group.
authors.affiliation: Department of Paediatric Intensive Care, Guy's Hospital, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Durward
authors.forename: S J
authors.initials: SJ
authors.lastname: Nicoll
authors.forename: J
authors.initials: J
authors.lastname: Oliver
authors.forename: S M
authors.initials: SM
authors.lastname: Tibby
authors.forename: I A
authors.initials: IA
authors.lastname: Murdoch
mesh_terms: D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D003440:Croup / Q000150:complications / Q000628:therapy*; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008131:London; D010360:Patient Transfer; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D019819:Budesonide