Abstract
Status asthmaticus is a frequent cause of admission to a pediatric intensive care unit (ICU). Children requiring intubation and mechanical ventilation for respiratory failure during these exacerbations comprise the most severely ill population of this cohort. The purpose of this study was to use a large multicenter database to determine the incidence of respiratory failure in children with acute asthma and to characterize clinical predictors associated with its occurrence. We conducted a retrospective data analysis of pediatric asthmatic patients included in the Virtual PICU Systems (VPS) database between January 2007 and December 2008. Patients requiring mechanical ventilation with cuffed or uncuffed nasotracheal or orotracheal tubes were characterized as having respiratory failure. Three thousand three hundred eighteen children were admitted with status asthmaticus during this study period, of which 201 (6.1%) had respiratory failure. There were no differences in age, male gender, or BMI between those with and those without respiratory failure. However, African-American children were significantly more likely to be intubated for status asthmaticus (OR 1.4; 95% CI 1.0–1.9; P=0.03) compared with the children of other races/ethnicities. Children with respiratory failure had significantly longer ICU lengths of stay, higher pediatric index of mortality (PIM2) scores, and higher pediatric risk of mortality (PRISM III) scores than children without respiratory failure. While respiratory failure occurs infrequently in children with status asthmaticus, it is associated with substantial hospitalization burden. In this large multicenter cohort, respiratory failure was not associated with age, gender, or obesity. However, African-American children were significantly more likely to be intubated for status asthmaticus.
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