title: Fatal and near-fatal asthma in children: the critical care perspective.
abstract: OBJECTIVE
  To characterize the clinical course, therapies, and outcomes of children with fatal and near-fatal asthma admitted to pediatric intensive care units (PICUs).
  
  
  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.
  
  
  CONCLUSIONS
  Of the children ventilated in the CPCCRN 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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. cnewth@chla.usc.edu
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Newth
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Meert
authors.forename: Amy E
authors.initials: AE
authors.lastname: Clark
authors.forename: Frank W
authors.initials: FW
authors.lastname: Moler
authors.forename: Athena F
authors.initials: AF
authors.lastname: Zuppa
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Murray M
authors.initials: MM
authors.lastname: Pollack
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Sward
authors.forename: John T
authors.initials: JT
authors.lastname: Berger
authors.forename: David L
authors.initials: DL
authors.lastname: Wessel
authors.forename: Rick E
authors.initials: RE
authors.lastname: Harrison
authors.forename: Jean
authors.initials: J
authors.lastname: Reardon
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carcillo
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shanley
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Allan
authors.initials: A
authors.lastname: Doctor
authors.forename: Carol E
authors.initials: CE
authors.lastname: Nicholson
mesh_terms: D000293:Adolescent; D000769:Anesthesia, Inhalation; D001249:Asthma / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D001784:Blood Gas Analysis; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008297:Male; D010359:Patient Readmission; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial; D012143:Respiratory Physiological Phenomena; D013224:Status Asthmaticus / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015996:Survival Rate