Clinical management practices of life-threatening asthma: an audit of practices in intensive care.

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Clinical management practices of life-threatening asthma: an audit of practices in intensive care.

Crit Care Resusc. 2019 Mar;21(1):53-62

Authors: Secombe P, Stewart P, Singh S, Campbell L, Stephens D, Tran K, White H, Sheehy R, Gibson J, Cooke R, Townsend S, Apte Y, Winearls J, Ferry OR, Pradhan R, Ziegenfuss M, Fong KM, Yang IA, McGinnity P, Meyer J, Walsham J, Boots R, Clement P, Bandeshe H, Gracie C, Jarret P, Collins S, Coulston C, Ng M, Howells V, Chatterjee I, Visser A, Smith J, Trout M, Critical Care Asthma Investigators

OBJECTIVE: Lack of management guidelines for lifethreatening asthma (LTA) risks practice variation. This study aims to elucidate management practices of LTA in the intensive care unit (ICU).
DESIGN: A retrospective cohort study.
SETTING: Thirteen participating ICUs in Australia between July 2010 and June 2013.
PARTICIPANTS: Patients with the principal diagnosis of LTA.
MAIN OUTCOME MEASURES: Clinical history, ICU management, patient outcomes, ward education and discharge plans.
RESULTS: Of the 270 (267 patients) ICU admissions, 69% were female, with a median age of 39 years (interquartile range [IQR], 26-53 years); 119 (44%) were current smokers; 89 patients (33%) previously required ICU admission, of whom 23 (25%) were intubated. The median ICU stay was 2 days (IQR, 2-4 days). Three patients (1%) died. Seventy-nine patients (29%) received non-invasive ventilation, with 11 (14%) needing subsequent invasive ventilation. Sixty-eight patients (25%) were intubated, with the majority of patients receiving volume cycled synchronised intermittent mechanical ventilation (n = 63; 93%). Drugs used included ß2-agonist by intravenous infusion (n = 69; 26%), inhaled adrenaline (n = 15; 6%) or an adrenaline intravenous infusion (n = 23; 9%), inhaled anticholinergics (n = 238; 90%), systemic corticosteroids (n = 232; 88%), antibiotics (n = 126; 48%) and antivirals (n = 22; 8%). When suitable, 105 patients (n = 200; 53%) had an asthma management plan and 122 (n = 202; 60%) had asthma education upon hospital discharge. Myopathy was associated with hyperglycaemia requiring treatment (odds ratio [OR], 31.6; 95% CI, 2.1-474). Asthma education was more common under specialist thoracic medicine care (OR, 3.0; 95% CI, 1.61-5.54).
CONCLUSION: In LTA, practice variation is common, with opportunities to improve discharge management plans and asthma education.

PMID: 30857513 [PubMed - in process]

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