title: Risk factors, management and outcomes of patients admitted with near fatal asthma to a tertiary care hospital in Riyadh.
abstract: BACKGROUND
  Near-fatal asthma (NFA) has not been well studied in Saudi Arabia. We evaluated NFA risk factors in asthmatics admitted to a tertiary-care hospital and described NFA management and outcomes.
  
  
  METHODS
  This was a retrospective study of NFA patients admitted to an ICU in Riyadh (2006-2010). NFA was defined as a severe asthma attack requiring intubation. To evaluate NFA risk factors, randomly selected patients admitted to the ward for asthma exacerbation were used as controls. Collected data included demographics, information on prior asthma control and various NFA treatments and outcomes.
  
  
  RESULTS
  Thirty NFA cases were admitted to the ICU in the five-year period. Compared to controls (N = 120), NFA patients were younger (37.5 ± 19.9 vs. 50.3 ± 23.1 years, P = 0.004) and predominantly males (70.0% vs. 41.7%, P = 0.005) and used less inhaled steroids/long-acting ß2-agonists combination (13.6% vs. 38.7% P = 0.024. Most (73.3%) NFA cases presented in the cool months (October-March). On multivariate analysis, age (odds ratio [OR] 0.96; 95% confidence interval [CI], 0.92-0.99, P = 0.015) and the number of ED visits in the preceding year (OR, 1.25; 95% CI, 1.00-1.55) were associated with NFA. Rescue NFA management included ketamine (50%) and theophylline (19%) infusions. NFA outcomes included: neuromyopathy (23%), mechanical ventilation duration = 6.4 ± 4.7 days, tracheostomy (13%) and mortality (0%). Neuromuscular blockade duration was associated with neuromyopathy (OR, 3.16 per one day increment; 95% CI, 1.27-7.83).
  
  
  CONCLUSIONS
  In our study, NFA risk factors were younger age and higher number of ED visits. NFA had significant morbidity. Reducing neuromuscular blockade duration during ventilator management may decrease neuromyopathy risk.
authors.affiliation: Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Al-Dorzi
authors.affiliation: Nursing College, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
authors.forename: Haifa A
authors.initials: HA
authors.lastname: Al-Shammary
authors.affiliation: Nursing College, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
authors.forename: Salha Y
authors.initials: SY
authors.lastname: Al-Shareef
authors.affiliation: Department of Epidemiology and Biostatistics, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
authors.forename: Hani M
authors.initials: HM
authors.lastname: Tamim
authors.affiliation: Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
authors.forename: Khaled
authors.initials: K
authors.lastname: Shammout
authors.affiliation: Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Al Dawood
authors.affiliation: Department of Intensive Care, King Abdulaziz Medical City and College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
keywords: Asthma; critical illness; mechanical ventilation; neuromyopathy