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Critical Care Interventions for Asthmatic Patients Admitted From the Emergency Department to the Pediatric Intensive Care Unit

Cundiff, Kristen Michelle, MD; Gerard, James M., MD; Flood, Robert G., MD

doi: 10.1097/PEC.0000000000001163
Original Articles
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Objectives The aim of this study was to assess the frequency and predictors of critical interventions in asthmatic patients admitted to the pediatric intensive care unit (PICU) at a tertiary-care pediatric hospital.

Methods We conducted a retrospective chart review of patients admitted from our emergency department (ED) to the PICU for treatment of status asthmaticus between January 1, 2008, and March 31, 2013. Patients with concomitant medical conditions and those who received a critical intervention, other than continuously aerosolized albuterol, in the ED before admission were excluded. Data collected included patient demographics, clinical characteristics including clinical asthma scores (CASs), hospital course, and adverse events.

Results A total of 384 patients were included in the analyses (mean age, 8.2 ± 4.5 years). Thirty-four patients (8.9%) received at least 1 critical intervention. No patients were intubated, had central venous catheter placement, and developed circulatory collapse or pneumothoraxes. Independent predictors associated with an increased likelihood of receiving a critical intervention included age above 8 years (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.9–9.4), previous PICU admission (OR, 3.2; 95% CI, 1.5–6.6), altered mental status on ED arrival (OR, 4.5; 95% CI, 1.5–13.4), CAS on ED arrival of 5 or greater (OR, 3.4; 95% CI, 1.3–9.1), and CAS on PICU admission of 5 or greater (OR, 4.3; 95% CI, 1.8–10.2).

Conclusions Patients admitted to the PICU for status asthmaticus infrequently require critical interventions if they have not been initiated in the ED. Patients with a CAS of less than 5 may be safely managed with continuously aerosolized albuterol on non–critical care units with low risk for clinical deterioration.

From the Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, Saint Louis, MO.

Disclosure: The authors declare no conflict of interest.

Reprints: Kristen Cundiff, MD, Department of Pediatrics, Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine and SSM Cardinal Glennon Children's Medical Center, 1465 South Grand Blvd, Saint Louis, MO 63104 (e-mail: covertkm@slu.edu).

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