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Multicenter Study
. 2018 Jul;53(7):857-865.
doi: 10.1002/ppul.24009. Epub 2018 Apr 10.

Children with severe acute asthma admitted to Dutch PICUs: A changing landscape

Shelley A Boeschoten  1 , Corinne M P Buysse  1 , Peter J F M Merkus  2 , Jacob M C van Wijngaarden  1 , Sabien G J Heisterkamp  3 , Johan C de Jongste  4 , Joost van Rosmalen  5 , Suzan C M Cochius-den Otter  1 , Annemie L M Boehmer  6 , Matthijs de Hoog  1 ; SKIC Dutch collaborative PICU research network
Collaborators, Affiliations
Multicenter Study

Children with severe acute asthma admitted to Dutch PICUs: A changing landscape

Shelley A Boeschoten et al. Pediatr Pulmonol. 2018 Jul.

Abstract

The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased.

Objectives: We investigated whether this trend in SAA PICU admissions is present in the Netherlands.

Methods: A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality.

Results: In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid-naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2-4 years [P = 0.026] and 5-17 years [P = 0.036]).

Conclusions: The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.

Keywords: intensive care; pediatric asthma; severe acute asthma; status asthmaticus; steroid-naïve.

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Figures

Figure 1
Figure 1
PICU admissions
Figure 2
Figure 2
Preschoolers versus school‐aged children
See this image and copyright information in PMC

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