TY - JOUR
T1 - Children with severe acute asthma admitted to Dutch PICUs
T2 - A changing landscape
AU - SKIC Dutch collaborative PICU research network
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 - Kneyber, Martin C.
N1 - © 2018 The Authors. Pediatric Pulmonology Published by Wiley Periodicals, Inc.
PY - 2018/7
Y1 - 2018/7
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.
U2 - 10.1002/ppul.24009
DO - 10.1002/ppul.24009
M3 - Article
C2 - 29635844
VL - 53
SP - 857
EP - 865
JO - Pediatric Pulmonology
JF - Pediatric Pulmonology
SN - 8755-6863
IS - 7
ER -