TY - JOUR
T1 - Children with severe acute asthma admitted to Dutch PICUs: A changing landscape
AU - on behalf of 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 - Lemson, Joris
AU - Roeleveld, P. P.
AU - Jansen, Nicolaas J. G.
AU - Kneyber, Martin C.
AU - van Waardenburg, Dick A.
AU - van Heerde, Marc
PY - 2018
Y1 - 2018
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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85045137624&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29635844
U2 - https://doi.org/10.1002/ppul.24009
DO - https://doi.org/10.1002/ppul.24009
M3 - Article
C2 - 29635844
SN - 8755-6863
VL - 53
SP - 857
EP - 865
JO - Pediatric pulmonology
JF - Pediatric pulmonology
IS - 7
ER -