Children with severe acute asthma admitted to Dutch PICUs: A changing landscape

SKIC Dutch collaborative PICU research network, Shelley A Boeschoten, Corinne M P Buysse, Peter J F M Merkus, Jacob M C van Wijngaarden, Sabien G J Heisterkamp, Johan C de Jongste, Joost van Rosmalen, Suzan C M Cochius-den Otter, Annemie L M Boehmer, Matthijs de Hoog

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Abstract

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.

Original languageEnglish
Pages (from-to)857-865
Number of pages9
JournalPediatric Pulmonology
Volume53
Issue number7
DOIs
Publication statusPublished - Jul-2018

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