title: Aminophylline infusion for status asthmaticus in the pediatric critical care unit setting is independently associated with increased length of stay and time for symptom improvement.
abstract: BACKGROUND
  The role of aminophylline in the treatment of severe acute asthma in the pediatric critical care unit (PCCU) is not clear. We sought to examine the association of aminophylline treatment with PCCU length of stay and time to symptom improvement.
  
  
  METHODS
  Patients with severe acute asthma who were admitted to our PCCU and received aminophylline infusion were retrospectively compared with similar patients who did not receive aminophylline. The primary outcome measure was functional length of stay (i.e. time to which patients could be transferred to a general pediatric ward bed). A secondary outcome was time to symptom improvement.
  
  
  RESULTS
  Adjusted functional length of stay was longer for subjects who received aminophylline (n = 49) than for the patients who did not (n = 47) (hazard ratio 0.396, p < 0.001), as well as the time for symptom improvement (hazard ratio 0.359, p < 0.001). In the group of subjects receiving aminophylline, those with a serum theophylline level ≥ 10 mcg/ml (therapeutic) (n = 31) had longer functional length of stay (hazard ratio 0.457, p = 0.0225) and time to symptom improvement (hazard ratio 0.403, p = 0.0085) than those with levels < 10 mcg/ml (sub-therapeutic) (n = 18).
  
  
  CONCLUSIONS
  The addition of aminophylline to therapy with corticosteroids and inhaled β-agonists was associated with statistically and clinically significant increases in functional length of stay and time to symptom improvement in the PCCU. This potential morbidity supports the National Asthma Education and Prevention Program guideline proscribing aminophylline use in acute asthma.
authors.affiliation: University of Missouri School of Medicine, Department of Child Health, Division of Pediatric Critical Care, 404 Keene St, Columbia, MO 65201, USA. Electronic address: dalabiha@missouri.edu.
authors.forename: Abdallah R
authors.initials: AR
authors.lastname: Dalabih
authors.affiliation: Vanderbilt University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care, USA. Electronic address: steven.a.bondi@vanderbilt.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Bondi
authors.affiliation: Northwestern University Feinberg School of Medicine, Division of Pediatric Critical Care, USA. Electronic address: zena.harris@vanderbilt.edu.
authors.forename: Zena L
authors.initials: ZL
authors.lastname: Harris
authors.affiliation: Vanderbilt University School of Medicine, Department of Biostatistics, USA. Electronic address: b.saville@vanderbilt.edu.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Saville
authors.affiliation: Vanderbilt University School of Medicine, Department of Biostatistics, USA. Electronic address: steffi4444@gmail.com.
authors.forename: Wenli
authors.initials: W
authors.lastname: Wang
authors.affiliation: Vanderbilt University School of Medicine, Department of, Pediatrics, Division of Emergency Medicine, USA; Center for Asthma & Environmental Sciences Research, USA. Electronic address: don.arnold@vanderbilt.edu.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000628:Aminophylline / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000188:drug therapy* / Q000503:physiopathology; D013806:Theophylline / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D000628:Aminophylline; D013806:Theophylline
keywords: Aminophylline; Asthma; EMR; FLOS; HR; IV; LOS; Length of stay; PCCU; Pediatric critical care; RDS; electronic medical record; functional length of stay; hazard ratio; intravenous; length of stay; mcg/ml; microgram per milliliters; n; number; pediatric critical care unit; respiratory distress score