title: Regional variation in ICU care for pediatric patients with asthma.
abstract: OBJECTIVE
  To determine adherence to guidelines for severe asthma care and evaluate regional variability in practice among pediatric intensive care units (PICU).
  
  
  METHODS
  A retrospective cohort study of children treated for asthma in a PICU during 2000 to 2003. We utilized the Pediatric Health Information System (PHIS) database to identify patients and determine use of asthma therapies when patients did not improve with standard therapy (inhaled beta-agonists and systemic corticosteroids).
  
  
  RESULTS
  Of 7125 children studied, 59% received inhaled anticholinergic medications. Use of other therapies included systemic beta-agonists (n = 1841 [26%]), magnesium sulfate (n = 1521 [21%]), methylxanthines (n = 426 [6%]), inhaled helium-oxygen gas mixture (heliox) (n = 740 [10%]), and endotracheal intubation with ventilation (n=1024 [14%]). Use of therapies varied by census region. Over half the patients (n = 524) who received ventilation did so for < or = 1 day. Adjusted for severity of illness, use of mechanical ventilation varied significantly by census division; however, much of the variation was among children ventilated for < or = 1 day.
  
  
  CONCLUSIONS
  Adherence to national guidelines for use of inhaled anticholinergics among critically ill children is low, and marked variation in use of invasive ventilation exists. More explicit guidelines regarding indications for invasive ventilation may improve asthma care.
authors.affiliation: University of Utah School of Medicine, Department of Pediatrics, Salt Lake City, Utah, USA. susan.bratton@hsc.utah.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
authors.forename: Jamie
authors.initials: J
authors.lastname: McCollegan
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
authors.forename: Fiona H
authors.initials: FH
authors.lastname: Levy
authors.forename: Heather T
authors.initials: HT
authors.lastname: Keenan
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000628:therapy*; D002648:Child; D015331:Cohort Studies; D003422:Critical Care; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006371:Helium / Q000627:therapeutic use; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007649:Ketamine / Q000627:therapeutic use; D008297:Male; D010100:Oxygen / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents; D018691:Excitatory Amino Acid Antagonists; D006371:Helium; C038949:heliox; D007649:Ketamine; D010100:Oxygen