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Who Are the Children Intubated Only Briefly for Status Asthmaticus?
October 2012, Vol 142, No. 4_MeetingAbstracts
Pediatrics | October 2012
Who Are the Children Intubated Only Briefly for Status Asthmaticus? Ranjini Srinivasan, MD; Richard Uluski, MD; Kathleen Sala, MPH; Laurie Karamessinis, RPFT; Sharon Smith, MD; Christopher Carroll*, MD Connecticut Children's Medical Center, Hartford, CT Chest. 2012;142(4_MeetingAbstracts):763A. doi:10.1378/chest.1387429
Abstract SESSION TYPE: Pediatric Critical Care PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM PURPOSE: Respiratory failure, although a relatively rare occurrence, carries a high burden of morbidity in children with asthma, with some requiring significant durations of mechanical ventilatory support. However, there are other children who require only short durations of intubations for status asthmaticus. Our objective was to characterize this population of children with status asthmaticus who require only brief durations of mechanical ventilation. METHODS: We conducted a retrospective review of children intubated for status asthmaticus using the multicenter VPS database. Clinical characteristics of children intubated for less than 24 hours were compared to those intubated for longer durations. RESULTS: Between 2009-2011, there were 2,746 children included in the VPS database who met study criteria; 1,030 (38%) were intubated less than 24 hours, and 1,716 were intubated for longer than 24 hours. The mean duration of intubation for children intubated for less than 24 hours was 9.6 + 7.2 hours compared to 6.9 + 8.0 days for children intubated more than 24 hours. Children intubated for less than 24 hours were older (78 ± 66 vs 64 ± 65 months, p<0.0001), and less likely to be African-American (OR 0.75, 95% CI 0.62-0.90, p=0.003) than children intubated for longer than 24 hours. There were no other significant differences in race/ethnicity or in gender between the two groups. Finally, of those intubated less than 24 hours, 94% were intubated outside the ICU, whereas only 59% of those intubated for more than 24 hours were intubated outside the ICU (OR 10, 95% CI 7.62-13.0, p<0.0001). Those associations persisted when accouting for illness severity on regression analysis. CONCLUSIONS: When compared to children intubated for longer durations, children with status asthmaticus who were intubated for less than 24 hours were older, less likely to be African-American, and 10 times more likely to be intubated outside of the ICU. CLINICAL IMPLICATIONS: These children with short durations of intubation may represent an acute asphyxial asthma phenotype or potentially a lower threshold for intubation by providers outside of the ICU setting. DISCLOSURE: The following authors have nothing to disclose: Ranjini Srinivasan, Richard Uluski, Kathleen Sala, Laurie Karamessinis, Sharon Smith, Christopher Carroll No Product/Research Disclosure Information Connecticut Children's Medical Center, Hartford, CT
Pediatrics | October 2012
Who Are the Children Intubated Only Briefly for Status Asthmaticus? Ranjini Srinivasan, MD; Richard Uluski, MD; Kathleen Sala, MPH; Laurie Karamessinis, RPFT; Sharon Smith, MD; Christopher Carroll*, MD Connecticut Children's Medical Center, Hartford, CT Chest. 2012;142(4_MeetingAbstracts):763A. doi:10.1378/chest.1387429
Abstract SESSION TYPE: Pediatric Critical Care PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM PURPOSE: Respiratory failure, although a relatively rare occurrence, carries a high burden of morbidity in children with asthma, with some requiring significant durations of mechanical ventilatory support. However, there are other children who require only short durations of intubations for status asthmaticus. Our objective was to characterize this population of children with status asthmaticus who require only brief durations of mechanical ventilation. METHODS: We conducted a retrospective review of children intubated for status asthmaticus using the multicenter VPS database. Clinical characteristics of children intubated for less than 24 hours were compared to those intubated for longer durations. RESULTS: Between 2009-2011, there were 2,746 children included in the VPS database who met study criteria; 1,030 (38%) were intubated less than 24 hours, and 1,716 were intubated for longer than 24 hours. The mean duration of intubation for children intubated for less than 24 hours was 9.6 + 7.2 hours compared to 6.9 + 8.0 days for children intubated more than 24 hours. Children intubated for less than 24 hours were older (78 ± 66 vs 64 ± 65 months, p<0.0001), and less likely to be African-American (OR 0.75, 95% CI 0.62-0.90, p=0.003) than children intubated for longer than 24 hours. There were no other significant differences in race/ethnicity or in gender between the two groups. Finally, of those intubated less than 24 hours, 94% were intubated outside the ICU, whereas only 59% of those intubated for more than 24 hours were intubated outside the ICU (OR 10, 95% CI 7.62-13.0, p<0.0001). Those associations persisted when accouting for illness severity on regression analysis. CONCLUSIONS: When compared to children intubated for longer durations, children with status asthmaticus who were intubated for less than 24 hours were older, less likely to be African-American, and 10 times more likely to be intubated outside of the ICU. CLINICAL IMPLICATIONS: These children with short durations of intubation may represent an acute asphyxial asthma phenotype or potentially a lower threshold for intubation by providers outside of the ICU setting. DISCLOSURE: The following authors have nothing to disclose: Ranjini Srinivasan, Richard Uluski, Kathleen Sala, Laurie Karamessinis, Sharon Smith, Christopher Carroll No Product/Research Disclosure Information Connecticut Children's Medical Center, Hartford, CT