TY - JOUR
T1 - Children with severe acute asthma admitted to Dutch PICUs
T2 - A changing landscape
AU - Boeschoten, Shelley A.
AU - Buysse, Corinne M.P.
AU - Merkus, Peter J.F.M.
AU - van Wijngaarden, Jacob M.C.
AU - Heisterkamp, Sabien G.J.
AU - de Jongste, Johan C.
AU - van Rosmalen, Joost
AU - Cochius-den Otter, Suzan C.M.
AU - Boehmer, Annemie L.M.
AU - de Hoog, Matthijs
AU - Lemson, Joris
AU - Roeleveld, P. P.
AU - Jansen, Nicolaas J.G.
AU - Kneyber, Martin C.
AU - van Waardenburg, Dick A.
AU - van Heerde, Marc
AU - SKIC Dutch collaborative PICU research network
N1 - Funding Information:
On behalf of SKIC study group: Joris Lemson, Radboud University Nijmegen Medical Center; PP Roeleveld, Leiden University Medical Center; Nicolaas JG Jansen, University Medical Center Utrecht; Martin C Kneyber, University Medical Center Groningen; Dick A van Waardenburg, Maastricht University Medical Center; Marc van Heerde, VU Medical Center Amsterdam, the Netherlands.
Funding Information:
Foundation for asthma control (Stichting Astma Bestrijding), Grant number: 2013/016; Ammodo (Institute of Art and Science)
Publisher Copyright:
© 2018 The Authors. Pediatric Pulmonology Published by Wiley Periodicals, Inc.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased. Objectives: We investigated whether this trend in SAA PICU admissions is present in the Netherlands. Methods: A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality. Results: In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid-naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2-4 years [P = 0.026] and 5-17 years [P = 0.036]). Conclusions: The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.
AB - The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased. Objectives: We investigated whether this trend in SAA PICU admissions is present in the Netherlands. Methods: A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality. Results: In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid-naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2-4 years [P = 0.026] and 5-17 years [P = 0.036]). Conclusions: The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.
KW - intensive care
KW - pediatric asthma
KW - severe acute asthma
KW - status asthmaticus
KW - steroid-naïve
U2 - 10.1002/ppul.24009
DO - 10.1002/ppul.24009
M3 - Article
SN - 8755-6863
VL - 53
SP - 857
EP - 865
JO - Pediatric Pulmonology
JF - Pediatric Pulmonology
IS - 7
ER -