Critical care for pediatric asthma: Wide care variability and challenges for study
Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. Pediatric Critical Care Medicine
(Impact Factor: 2.34).
11/2011; 13(4):407-14. DOI: 10.1097/PCC.0b013e318238b428
To describe pediatric severe asthma care, complications, and outcomes to plan for future prospective studies by the Collaborative Pediatric Critical Care Research Network.
Retrospective cohort study.
: Pediatric intensive care units in the United States that submit administrative data to the Pediatric Health Information System.
Children 1-18 yrs old treated in a Pediatric Health Information System pediatric intensive care unit for asthma during 2004-2008.
Thirteen-thousand five-hundred fifty-two children were studied; 2,812 (21%) were treated in a Collaborative Pediatric Critical Care Research Network and 10,740 (79%) were treated in a non-Collaborative Pediatric Critical Care Research Network pediatric intensive care unit. Medication use in individual Collaborative Pediatric Critical Care Research Network centers differed widely: ipratropium bromide (41%-84%), terbutaline (11%-74%), magnesium sulfate (23%-64%), and methylxanthines (0%-46%). Complications including pneumothorax (0%-0.6%), cardiac arrest (0.2%-2%), and aspiration (0.2%-2%) were rare. Overall use of medical therapies and complications at Collaborative Pediatric Critical Care Research Network centers were representative of pediatric asthma care at non-Collaborative Pediatric Critical Care Research Network pediatric intensive care units. Median length of pediatric intensive care unit stay at Collaborative Pediatric Critical Care Research Network centers was 1 to 2 days and death was rare (0.1%-3%). Ten percent of children treated at Collaborative Pediatric Critical Care Research Network centers received invasive mechanical ventilation compared to 12% at non-Collaborative Pediatric Critical Care Research Network centers. Overall 44% of patients who received invasive mechanical ventilation were intubated in the pediatric intensive care unit. Children intubated outside the pediatric intensive care unit had significantly shorter median ventilation days (1 vs. 3), pediatric intensive care unit days (2 vs. 4), and hospital days (4 vs. 7) compared to those intubated in the pediatric intensive care unit. Among children who received mechanical respiratory support, significantly more (41% vs. 25%) were treated with noninvasive ventilation and significantly fewer (41% vs. 58%) were intubated before pediatric intensive care unit care when treated in a Pediatric Health Information System hospital emergency department.
Marked variations in medication therapies and mechanical support exist. Death and other complications were rare. More than half of patients treated with mechanical ventilation were intubated before pediatric intensive care unit care. Site of respiratory mechanical support initiation was associated with length of stay.
Available from: Brian K Walsh
Respiratory care 11/2012; 57(11):1982-3. DOI:10.4187/respcare.02167 · 1.84 Impact Factor
Available from: Christopher L Carroll
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ABSTRACT: Status asthmaticus is a frequent cause of admission to a pediatric intensive care unit. Prompt assessment and aggressive treatment are critical. First-line or conventional treatment includes supplemental oxygen, aerosolized albuterol, and corticosteroids. There are several second-line treatments available; however, few comparative studies have been performed and in the absence of good evidence-based treatments, the use of these therapies is highly variable and dependent on local practice and provider preference. In this article the pathophysiology and treatment of status asthmaticus is discussed, and the literature regarding second-line treatments is critically assessed to apply an evidence basis to the treatment of this severe disease.
Critical care clinics 04/2013; 29(2):153-66. DOI:10.1016/j.ccc.2012.12.001 · 2.16 Impact Factor
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ABSTRACT: Acute respiratory failure is common in critically ill children, who are at increased risk of respiratory embarrassment because of the developmental variations in the respiratory system. Although multiple etiologies exist, pneumonia and bronchiolitis are most common. Respiratory system monitoring has evolved, with the clinical examination remaining paramount. Invasive tests are commonly replaced with noninvasive monitors. Children with ALI/ARDS have better overall outcomes than adults, although data regarding specific therapies are still lacking. Most children will have some degree of long-term physiologic respiratory compromise after recovery from ALI/ARDS. The physiologic basis for respiratory failure and its therapeutic options are reviewed here.
Critical care clinics 04/2013; 29(2):167-83. DOI:10.1016/j.ccc.2012.12.004 · 2.16 Impact Factor
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