Acute severe asthma: differences in therapies and outcomes among pediatric intensive care units.
OBJECTIVE
To determine differences in therapies and outcomes among pediatric intensive care units for patients with acute severe asthma.


METHODS
Retrospective cohort study.


METHODS
Eleven pediatric intensive care units participating in the Pediatric Intensive Care Evaluations.


METHODS
Patients were 1528 children with a primary diagnosis of asthma.


METHODS
None.


RESULTS
We studied severity of illness, length of stay, and use of invasive interventions. The patients at the centers had similar median physiologic measures of illness and Pediatric Risk of Mortality III scores. The patients received a wide range of invasive interventions depending on institution, including mechanical ventilation (3% to 47%), arterial catheter placement (4% to 46%), central venous catheter (2% to 51%), and determination of a blood gas (24% to 70%). At institutions where mechanical ventilation was used more commonly (>20%, high use), intensive care and hospital stays were longer for asthmatic patients regardless of mechanical ventilation requirement compared with centers with lower use of mechanical ventilation. The status of "high-use center" was an independent predictor for intensive care stay (p = .005) and hospital length of stay (p = .017) as well as duration of mechanical ventilation (p = .014) after adjustment for age, degree of hypercarbia, maximal respiratory rate, use of an arterial catheter, and Pediatric Risk of Mortality III scores among ventilated children.


CONCLUSIONS
We found that use of invasive interventions including mechanical ventilation and vascular monitoring varied greatly by institution. Centers with higher use of mechanical ventilation had longer median intensive care stay and hospital stays. Pediatric asthma management for acute severe asthma may be improved by clear elucidation of the institutional practices where fewer invasive interventions were used to achieve better outcomes.
Roberts
Joan S
JS
Department of Pediatrics, University of Washington School of Medicine, Children's Hospital, Seattle, USA.
Bratton
Susan L
SL
Brogan
Thomas V
TV
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013224:Status Asthmaticus / Q000401:mortality / Q000628:therapy*; D014481:United States / Q000453:epidemiology