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Volume 42, Number 6, December 2009

Clinical course and outcome of children with status asthmaticus treated in a pediatric intensive care unit: a 15-year review


Bor-Luen Chiang, Chin-Tung Hsieh, Li-Chieh Wang, Jyh-Hong Lee, Hsin-Hui Yu, Yu-Tsan Lin, Yao-Hsu Yang


Received: July 21, 2007    Revised: January 4, 2008    Accepted: March 1, 2008   

 

Corresponding author:

Dr. Bor-Luen Chiang, Department of Pediatrics, National Taiwan University Hosptial, No. 7 Zhong-Shan South Rd., Taipei, Taiwan. E-mail: gicmbor@ntu.edu.tw



 

Background and purpose: 

The purpose of this study was to analyze the clinical course and outcomes of children with status asthmaticus treated in a pediatric intensive care unit (PICU) in Taiwan.



 

Methods:

The medical charts of all patients aged from 2 to 18 years with status asthmaticus who were admitted to the PICU National Taiwan University Hospital, Taipei, Taiwan, from 1990 to 2006 were reviewed retrospectively.



 

Results:

Twenty eight children were admitted on 33 occasions; 4 patients had more than 1 admission. The mean age was 6.23 years (range, 2-17 years). No control medication was regularly used prior to admission for 81.8% of the episodes. The mean PICU stay was 2.55 days (range, 1-13 days) and, for 78.8% of episodes, the patients were discharged from the ICU within 2 days. For 11 episodes (33.3%), the patients required mechanical ventilation for a mean duration of 3.6 days. The mortality rate was 3.3% (n = 1). Complications included bronchopneumonia (57.6%), hemodynamic compromise (9.1%), neurologic symptoms (6.1%), and air leak (3.3%). Patients requiring mechanical ventilation had significantly lower initial pulse oximeter oxygen saturation (<90%), lower blood gas pH (<7.25), higher partial pressure of carbon dioxide, and longer duration of PICU and hospital stay (p< 0.05) when compared with patients not requiring mechanical ventilation. For patients with a history of repeated PICU admissions for asthma, the intubation rate was 77.7%.



 

Conclusion:

The prognosis for childhood status asthmaticus is favorable. The most common trigger factors were respiratory tract infection and poor asthma control.



 

Key words:

Intensive care units, pediatric; Status asthmaticus