Chest
Volume 120, Issue 5, November 2001, Pages 1616-1621
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Clinical Investigations in Critical Care
Clinical Course and Outcome of Patients Admitted to an ICU for Status Asthmaticus

https://doi.org/10.1378/chest.120.5.1616Get rights and content

Study objectives

To describe the prognostic factors, clinical course, and outcome of patients with status asthmaticus treated in a medical ICU (MICU).

Design

Analysis of prospective data.

Setting

A multidisciplinary MICU of an inner-city university hospital.

Patients

We collected data on 132 hospital admissions of 89 patients with status asthmaticus treated in our MICU from August 1995 through July 1998.

Measurements

APACHE (acute physiology and chronic health evaluation) II scores were among the parameters measured.

Results

Seventy-nine percent of the patients were female, and 67% were African American (mean ± SD age, 42.4 ± 15.1 years). Patients in 48 of the 132 hospital admissions (36%) required invasive mechanical ventilation; sepsis developed in patients during 17 hospital admissions (13%), nonpulmonary organ failure developed during 16 hospital admissions (12%), and ARDS developed during 2 hospital admissions (2%). Pneumothorax developed in four patients and required tube thoracostomy in all four patients. The median APACHE II score was 11. Predicted mortality and actual mortality were 6.7% and 8.3%, respectively. The two most common immediate causes of death were pneumothorax (n = 3) and nosocomial infection (n = 3). All the deaths occurred in female patients. Compared with survivors, nonsurvivors had higher APACHE II scores (median, 26 vs 15; p < 0.0001), Paco2 (63.8 ± 21.3 mm Hg vs 47.8 ± 19.1 mm Hg, p = 0.0101), and lower arterial pH (7.09 ± 0.12 vs 7.27 ± 0.12, p < 0.0001), respectively. Patients in 10 of 48 hospital admissions (21%) who required mechanical ventilation died.

Conclusions

The hospital mortality of patients admitted to an MICU for status asthmaticus is higher than expected. Higher APACHE II score and Paco2 and lower arterial pH within 24 h of hospital admission are associated with increased mortality. Sepsis and nonpulmonary organ failure are more likely to develop in nonsurvivors than survivors.

Section snippets

Materials and Methods

The study involves prospectively collected data of 132 hospital admissions of 89 patients with status asthmaticus. The data were collected as part of the screening of patients admitted to our medical ICU (MICU) for severe exacerbation of asthma or chronic obstructive airway disease for a prospective, randomized study comparing permissive hypercapnia and conventional ventilation. This study included patients in all 132 hospital admissions who were consecutively treated in our MICU over the

Results

The age at first hospital admission, race, and sex of the 89 patients are listed in Table 1. During the 3-year study period, 1 patient was admitted to the MICU nine times, 1 patient was admitted seven times, 2 patients were admitted five times, 2 patients were admitted four times, 5 patients were admitted three times, 5 patients were admitted twice, and 73 patients were admitted once.

The age of the patients at admission to the MICU was 41.9 ± 15.0 years. Invasive mechanical ventilation was

Discussion

In this study, most of the 89 patients admitted to an MICU of an inner-city hospital for status asthmaticus were African American and female. Nonpulmonary organ failure and sepsis developed in patients in 12% and 13% of the 132 hospital admissions, respectively. The in-hospital mortality rate of 8% was higher than the mortality rate predicted by the APACHE II prognostic system. Although it did not reach statistical significance, none of the male patients died, compared with 11 of the 70 female

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