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. 2024 Sep 12;14(5):1886-1897.
doi: 10.3390/clinpract14050149.

Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care

Adam J R Watson  1   2 , Thomas Roe  1 , Oliver Arscott  1 , Charlotte Thomas  1 , James Ward  1 , Ryan Beecham  1 , David Browning  3 , Kordo Saeed  2   3 , Ahilanandan Dushianthan  1   2   4
Affiliations

Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care

Adam J R Watson et al. Clin Pract. .

Abstract

Background: There is limited evidence regarding the management of acute life-threatening asthma in intensive care units (ICUs), and few guidelines have details on this. We aimed to describe the characteristics, management, and outcomes of adults with life-threatening asthma requiring ICU admission.

Methods: In this single-centre retrospective observational study, we included consecutive adults with acute asthma requiring ICU admission between 1 January 2016 and 31 December 2023. Our primary outcome was requirement for invasive mechanical ventilation (IMV).

Results: We included 100 patients (median age 42.5 years, 67% female). The median pH, PaCO2, and white cell count (WCC) on ICU admission were 7.37, 39 mmHg, and 13.6 × 109/L. There were 30 patients (30%) who required IMV, and the best predictors of IMV requirement were pH (AUC 0.772) and PaCO2 (AUC 0.809). In univariate analysis, IMV requirement was associated with both increasing WCC (OR 1.14) and proven bacterial infection (OR 8.50). A variety of respiratory support strategies were utilised, with 38 patients (38%) receiving only non-invasive respiratory support.

Conclusions: Our data highlight key characteristics which may be risk factors for acute asthma requiring ICU admission and suggest that pH, PaCO2, and WCC are prognostic markers for disease severity. Our overall outcomes were good, with an IMV requirement of 30% and a 28-day mortality of 1%.

Keywords: asthma; intensive care unit; life-threatening; near fatal; ventilation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of eligible, included, and excluded patients.
Figure 2
Figure 2
Proportion of patients admitted to ICU over time according to maximum level of respiratory support.
Figure 3
Figure 3
AUROC analysis for pH, PaCO2, and WCC on ICU admission as predictors of IMV requirement. Red solid line represents random predictor.
See this image and copyright information in PMC

References

    1. Mims J.W. Asthma: Definitions and pathophysiology. Int. Forum Allergy Rhinol. 2015;5((Suppl. 1)):S2–S6. doi: 10.1002/alr.21609. - DOI - PubMed
    1. GBD 2019 Diseases and Injuries Collaborators Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–1222. doi: 10.1016/S0140-6736(20)30925-9. - DOI - PMC - PubMed
    1. Public Health Profiles—OHID. [(accessed on 8 July 2024)]. Available online: https://fingertips.phe.org.uk/search/asthma.
    1. Pendergraft T.B., Stanford R.H., Beasley R., Stempel D.A., Roberts C., McLaughlin T. Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations. Ann. Allergy Asthma Immunol. 2004;93:29–35. doi: 10.1016/S1081-1206(10)61444-5. - DOI - PubMed
    1. Stow P.J., Pilcher D., Wilson J., George C., Bailey M., Higlett T., Bellomo R., Hart G.K., the Australian. New Zealand Intensive Care Society Adult Patient Database Management Committee Improved outcomes from acute severe asthma in Australian intensive care units (1996 2003) Thorax. 2007;62:842–847. doi: 10.1136/thx.2006.075317. - DOI - PMC - PubMed

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