Outcome of children with life-threatening asthma necessitating pediatric intensive care

Objective: To report the outcome of children with life-threatening asthma (LTA) admitted to a university Pediatric Intensive Care Unit (PICU). Methods: Retrospective study between October 2002 and May 2010 was carried out. Every child with LTA and bronchospasm was included. Results: 30 admissions of 28 patients (13 M, 17 F) were identified which accounted for 3% of total PICU admissions (n = 1033) over the study period. The majority of patients were toddlers (median age 3.1 years). Few had past history of prematurity, lung diseases, or neuro-developmental conditions. Approximately half had previous admissions for asthma and one-forth with history of non-compliance to recommended treatment for asthma. One patient had parainfluenza virus and one had rhinovirus isolated. None of these factors were associated with need for mechanical ventilation (n = 6 admissions). Comparing with patients who did not receive mechanical ventilation, ventilated children had significantly higher PIM2 score (1.65 versus 0.4, p < 0.001), higher PCO2 levels (9.3 kPa versus 5.1 kPa, p = 0.01) and longer PICU stay (median 2.5 days versus 2 days, p = 0.03) The majority of patients received systemic corticosteroids, intravenous or inhaled bronchodilators. There was one pneumothorax but no death in this series. Conclusions: LTA accounted for a small percentage of PICU admissions. Previous hospital admissions for asthma and history of non-compliance were common. Approximately one quarters required ventilatory supports. Regardless of the need for mechanical ventilation, all patients survived with prompt treatment.