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Abstract P-608: WIDE VARIABILITY OF INTENSIVE CARE TREATMENT FOR STATUS ASTHMATICUS AMONG 20 LATINAMERICAN PICUs. A REPORT FROM THE LATINAMERICAN PEDIATRIC COLLABORATIVE NETWORK (LARED)

Monteverde-Fernandez, N.1; González-Dambrauskas, S.2; Diaz, F.3; Carvajal, C.4; Serra, J.2; Wegner, A.5; Cordoba, T.6; Bravo, A.7; Aranguiz, D.8; Carbonell, M.9; Alonso, B.2; Pedrozo, L.10; Castro, L.11; Matrai, L.12; Benech, E.13; Carro, M.14; Cruces, P.6; Pastorini, J.15; Ruibal, M.16

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Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 236-237
doi: 10.1097/01.pcc.0000538065.28847.a4
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Aims & Objectives:

To detect variability of intensive care treatments for status asthmaticus (SA) among latinamerican PICUs

Methods

Cohort study of children older than 2 years old admitted with (SA) to 20 PICUs from LARed (from five countries) between May and November 2017. Data showed as median IQR and frequency as percentage and range.

Results

Of 1157 children admitted, 101 were included in the analysis. 53.5%male, 67.9 (39.1,96.7) mo. 30.7% had no previous history of asthma. Admission M-WCAS was 5 (4.5, 6), PIM3 0.48(0.21,6.2) and SatO2/FiO2 index 226 (190, 300). Admission x-ray was present in 93.1%, lung hyperinflation was observed in 86.9%. There was significant variation of maximum respiratory support between centers: Invasive MV 8.9 % (0,100) %, BIPAP 41.6 % (0,100), HFNC 31.7% (0, 100) (p<0.001). All patients received systemic steroids. Salbutamol use was frequent 98% (50–100), although preferred route varied between centers: scheduled nebulization 92.1% (50–100) p<0.001, intravenous 7.9%(0–50%) (p<0.002). Remarkably none of the centers used beta agonist continuous nebulization. Other bronchodilator therapies were: Ipatropium 74.3%(0–100) p<0.001, Methylxantines 46.5%(0–100%) p<0.001, Magnesium Sulphate 26.7%(0–75) p=0.012. Antibiotics were prescribed on 61.4% (25–100) p=0.5. Complications were unfrequented, air leak was present in 2.1%. PICU LOS was 3.5 days(2.2,5.8). Mortality 0%

Conclusions

Significant variation of intensive care treatments exist in respiratory support and pharmacological therapies for SA in Latinamerican PICUs. Compliance with current guidelines and evidence-based recommendations were non-consistent among centers. Future collaborative research needs to focus on developing a step-wise approach to decrease variability, reduce both under and overuse and then improving outcomes.

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies