Original ArticleFatal and Near-Fatal Asthma in Children: The Critical Care Perspective
Section snippets
Methods
A retrospective study was conducted across the 8 children’s hospitals of the CPCCRN. Patients aged 1-18 years with a primary admitting diagnosis of acute exacerbation of asthma or status asthmaticus who were deemed ill enough to require admission to the PICU of any CPCCRN hospital for ongoing therapy were defined as having critical asthma. (We acknowledge that our definition of critical asthma is not universally accepted. The term “critical asthma” has been earlier used in clinical practice
Results
A total of 261 patients with near-fatal and fatal asthma were identified across the CPCCRN sites during the 5-year study period, of whom 260 (99.6%) were intubated and ventilated. One patient was not intubated and died, and 10 (4%) of the intubated patients died. All fatal cases had been admitted to the PICU before death. Case demographic data by study site are presented in Table I (available at www.jpeds.com). Comparing our asthma cohort with overall CPCCRN admissions during the study period
Discussion
In this study, most of the pediatric patients with asthma who received mechanical ventilation and were admitted to a CPCCRN PICU survived without short-term complications. Ten of the 11 children in our cohort who died experienced cardiac arrest before PICU admission. Geographic location of endotracheal intubation is correlated with LMV. African-American children were significantly overrepresented in our sample, and Hispanic children were underrepresented. Barotrauma during the course of
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Supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (cooperative agreements U10-HD050012, U10-HD050096, U10-HD063108, U10-HD049983, U10-HD049981, U10-HD063114, and U10-HD063106), the Obstetric and Pediatric Pharmacology Branch, and the Best Pharmaceuticals for Children Act. The authors declare no conflicts of interest.
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A list of members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network is available at www.jpeds.com (Appendix).