title: Corticosteroid therapy in critically ill pediatric asthmatic patients.
abstract: OBJECTIVE
  IV corticosteroids are routinely prescribed to treat critically ill children with asthma. However, no specific dosing recommendations have been made for children admitted to the PICU. We aim to determine current asthma corticosteroid dosing preferences in PICUs within North America.
  
  
  METHODS
  Cross-sectional, self-administered survey.
  
  
  METHODS
  North American PICUs.
  
  
  METHODS
  Pediatric intensivists working in the United States and Canada.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 104 intensivists completed the survey. Of these, 70% worked in the United States, 67% attended in PICUs with at most 20 beds, and 79% had more than 10 years of PICU experience. The majority of asthmatics were admitted to PICUs based on clinical asthma examination/score or because the patient was receiving continuous albuterol. IV methylprednisolone is prescribed by a large majority of intensivists (96%). Of those who prescribe methylprednisolone, 66% use a starting dose of 4 mg/kg/d, whereas 31% use a starting dose of 2 mg/kg/d, and only 3% use 1 mg/kg/d. The large majority of respondents (85%) use "clinical experience" as their rationale for their preferred dosage. In multivariate logistic regression analysis, only knowledge of the National Heart, Lung, and Blood Institute guidelines was an independent predictor of prescribing an initial corticosteroid dose of 4 mg/kg/d (odds ratio, 3.69 [95% CI, 1.26-10.80]; p = 0.017). Country of practice, years of experience, and PICU size were not associated with corticosteroid dosing preference.
  
  
  CONCLUSIONS
  Most intensivists administer methylprednisolone to critically ill asthmatics at doses 2 to 4 times higher than recommended by the National Heart, Lung, and Blood Institute guidelines for hospitalized asthmatic children. The rationale for these decisions is likely multifactorial, but in the absence of evidence-based data, most of them cite clinical experience as their deciding factor. Future research is needed to determine the most appropriate corticosteroid dosage in this critically ill patient population.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA. John.giuliano@yale.edu
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
authors.forename: Edward Vincent S
authors.initials: EV
authors.lastname: Faustino
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Pinto
authors.forename: Michael F
authors.initials: MF
authors.lastname: Canarie
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002170:Canada; D002648:Child; D016638:Critical Illness / Q000628:therapy*; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006801:Humans; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D000420:Albuterol; D008775:Methylprednisolone