Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations

Pendergraft, Trudy; Stanford, Richard H.; Beasley, Richard; Stempel, David A.; Roberts, C.S.; McLaughlin, Trent

doi:10.1016/s1081-1206(10)61444-5

Cited by 107 publications

(89 citation statements)

References 31 publications

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“…Previous studies that provided estimates of hospital mortality from asthma exacerbations were limited to individual hospitals or intensive care units or were from regions outside the United States. These studies supported a wide range of hospital mortality estimates (0.4-12%) (22)(23)(24). Our findings, based on nationally representative data, indicate that the overall risk of death in patients hospitalized for asthma exacerbations in the United States is 0.5%.…”

Section: Discussionsupporting

confidence: 84%

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Krishnan

Diette

Rańd

et al. 2006

Am J Respir Crit Care Med

187

125

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Rationale: Hospitalizations for asthma exacerbations are common in the United States, but there are no national estimates of outcomes in this population. It is also not known if race disparities in asthma deaths exist among hospitalized patients. Objectives: To estimate outcomes of patients hospitalized for asthma in the United States and to determine if the risk of death in this population is higher among black patients compared with white patients. Methods: We used the Nationwide Inpatient Sample for 2000. Admissions for asthma exacerbations among patients Ͼ 5 yr of age were included. Mortality was the primary outcome; secondary outcomes were length of stay and total hospital charges. Measurements and Main Results:In-hospital asthma mortality was 0.5% (99% confidence interval [CI], 0.4-0.6), with mean hospital stay of 2.7 d (99% CI, 2.6-2.8 d) and $9,078 (99% CI, $8,300-9,855) in hospital charges. Deaths in this population accounted for about one-third of all asthma deaths reported in the United States. Black patients hospitalized for asthma exacerbations were less likely to die when compared with white patients (0.3 vs. 0.6%; p Ͻ 0.001). However, in multivariable analyses, there were no significant race differences in hospital deaths. Conclusions: Mortality among patients hospitalized for asthma exacerbations accounts for one-third of all deaths from asthma. The higher overall risk of death from asthma in black patients compared with white patients in the United States is not explained by race differences in hospital deaths and therefore is attributable to factors preceding hospitalization.

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Section: Discussionsupporting

confidence: 84%

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Krishnan

Diette

Rańd

et al. 2006

Am J Respir Crit Care Med

187

125

View full text Add to dashboard Cite

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“…The in-hospital mortality rate for all patients hospitalized during the three years studied was 0.8% (95% CI: 0.6-1.2), which is in accordance with previous estimates of in-hospital mortality at individual hospitals and in ICU units, as well as with nationally representative data. (9,10) Furthermore, there was a reduction in the frequency of cardiopulmonary arrest (2.9% in 1994, 2.7% in 1999 and 1.8% in 2004) although the difference was not statistically significant (p = 0.2).…”

Section: Discussionmentioning

confidence: 93%

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

et al. 2009

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Objective: Studies assessing the characteristics and management of patients hospitalized with asthma have been limited to a small number of facilities and have evaluated short time periods. The present study evaluated long-term changes among hospitalized asthma patients at a large number of facilities. Methods: This was a retrospective, hospital-based observational case series, designated the Study of Severe Asthma in Latin America and Spain, which was conducted in Spain and in eight Latin-American countries. We reviewed the hospital records of 3,038 patients (age range, 15-69 years) hospitalized with acute severe asthma at one of nineteen tertiary-care hospitals in 1994, 1999 and 2004. Results: Over time, the use of inhaled corticosteroids and long-acting β 2 agonists increased significantly, whereas the use of theophylline as a controller medication decreased. The utilization of pulmonary function tests also increased. There was a significant reduction in the mean hospital stay (8.5 days, 7.4 days and 7.1 days in 1994, 1999 and 2004, respectively, p = 0.0001) and a significant increase in the mean of the lowest arterial pH at hospital admission. In contrast, there was a significant decrease in the proportion of cases in which PEF was determined in the emergency room (48.6% in 1994 vs. 43.5% in 2004, p = 0.0001). We found the quality of asthma management and care to be generally better in Spain than in Latin America. Conclusions: Although there have been certain improvements in the management of asthma between severe exacerbations and during hospitalization, asthma management remains suboptimal in Spain and, especially, in Latin America.Keywords: Status asthmaticus; Asthma/therapy; Hospitalization. ResumoObjetivo: Estudos que avaliem as características e o gerenciamento de pacientes asmáticos hospitalizados têm sido limitados a um número pequeno de serviços e a curtos períodos de duração. O presente estudo avaliou alterações de longo prazo de pacientes asmáticos hospitalizados em um grande número de serviços. Métodos: Estudo retrospectivo, observacional, de base hospitalar, denominado Estudo sobre Asma Grave na América Latina e Espanha, realizado na Espanha e em oito países da América Latina. Foi realizada uma revisão dos registros hospitalares de 3.038 pacientes (variação de idade, 15-69 anos) hospitalizados com asma aguda grave em um dos 19 hospitais terciários em 1994, 1999 e 2004. Resultados: Ao longo do tempo, o uso de corticosteroides inalatórios e de β 2 -agonistas aumentou significativamente, ao passo que o uso de teofilina, como medicação de controle, decaiu. A utilização de testes de função pulmonar também aumentou. Houve uma redução significativa da média do tempo de internação (8,5 dias, 7,4 dias e 7,1 dias em 1994, 1999 e 2004, respectivamente; p = 0,0001) e um aumento significativo da média do menor pH arterial na admissão. Em contrapartida, houve uma diminuição significativa na proporção de casos submetidos ao PFE no pronto-socorro (48,6% em 1994 vs. 43,5% em 2004; p = 0,0001).O tratamen...

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“…An earlier study of 215 hospitals demonstrated a $3000 cost difference between standard asthma admissions and asthma admissions to the ICU without mechanical ventilation. 20 Although this study included adults and may not directly reflect the cost differential for ICU care for children with asthma, our findings have implications for strategies to safely reduce the cost of asthma hospital care.…”

Section: Discussionmentioning

confidence: 95%

Safety and Effectiveness of Continuous Aerosolized Albuterol in the Non–Intensive Care Setting

Kenyon¹,

Fieldston²,

Luan³

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Continuously aerosolized albuterol been shown to be safe and effective for the treatment of severe status asthmaticus in the emergency department and ICU. Little evidence supports its use in the non-intensive care setting. WHAT THIS STUDY ADDS:With the appropriate resources and support, continuous albuterol may be administered in the non-ICU setting with a low incidence of clinical deterioration and adverse effects. Certain clinical factors may help identify which patients may benefit from higher acuity care. abstract OBJECTIVE: To describe the design features, utilization, and outcomes of a protocol treating children with status asthmaticus with continuous albuterol in the inpatient setting. METHODS:We performed a retrospective cohort analysis of children ages 2 to 18 treated in the non-intensive care, inpatient setting on a standardized treatment protocol for status asthmaticus from July 2011 to June 2013. We assessed characteristics associated with continuous albuterol therapy and, for those treated, duration of therapy and the proportion who clinically deteriorated (ICU transfer or progression to enhanced respiratory support) or who were identified as having hypokalemia or an arrhythmia. Using multivariable logistic regression, we determined which factors were associated with clinical deterioration or prolonged (.24 hours) continuous albuterol. RESULTS:Of 3003 children meeting study criteria, 1298 (43%) received continuous albuterol. Older age, black race, lower initial oxygen saturation, and higher initial age-standardized heart rate and respiratory rate were associated with initiation of continuous albuterol therapy (P , .001 for all). Median duration of therapy was 14.4 hours (interquartile range, 7.7, 24.6); 340 children (26%) experienced prolonged therapy. Seventy children (5%) experienced clinical deterioration, and 33 children (3%) had identified hypokalemia or arrhythmia. Comorbid pneumonia and emergency department administration of intravenous magnesium or subcutaneous terbutaline were associated with prolonged therapy and clinical deterioration. CONCLUSIONS:With appropriate support structures and care processes, continuous albuterol can be delivered effectively in the non-ICU, inpatient setting with low rates of adverse outcomes. Certain initial clinical characteristics may help identify patients needing more intensive therapy. Pediatrics 2014;134:e976-e982 AUTHORS:

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Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations

Cited by 107 publications

References 31 publications

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

Mortality in Patients Hospitalized for Asthma Exacerbations in the United States

The study of severe asthma in Latin America and Spain (1994-2004): characteristics of patients hospitalized with acute severe asthma

Safety and Effectiveness of Continuous Aerosolized Albuterol in the Non–Intensive Care Setting

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