Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Setting
2.2. Inclusion and Exclusion Criteria
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Clinical Presentation
3.3. Patient Outcomes
3.4. Outcome Predictors
3.5. Management
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All Patients (n = 100) | Invasive Mechanical Ventilation (n = 30) | Non-Invasive Respiratory Support (n = 38) | No Respiratory Support (n = 32) | p | |
---|---|---|---|---|---|
Patient Characteristics | |||||
Age (years) | 42.5 (32.0–53.3) | 43.0 (32.0–50.0) | 46.0 (32.5–55.8) | 41.0 (30.3–50.0) | 0.573 |
Female sex | 67 (67) | 20 (70) | 26 (68) | 20 (63) | 0.869 |
White ethnicity | 88 (88) | 27 (90) | 34 (89) | 27 (84) | 0.745 |
Body Mass Index (kg/m2) | 27.7 (24.0–34.6) | 27.6 (23.9–37.1) | 29.1 (24.1–34.6) | 27.2 (23.7–33.3) | 0.755 |
Charlson CI | 0 (0–2) | 0 (0–3) | 2 (0–3) | 0 (0–1) | 0.064 |
Clinical Frailty Scale | 2 (1–3) | 2 (1–4) | 2 (1–4) | 1 (1–3) | 0.199 |
Current smoker | 22 (22) | 7 (23) | 9 (24) | 6 (19) | 0.865 |
Former smoker | 26 (26) | 8 (27) | 9 (24) | 8 (25) | 0.961 |
COPD | 9 (9) | 0 (0) | 8 (21) | 1 (3) | <0.001 |
Asthma Characteristics | |||||
Previous ICU admission | 32 (32) | 13 (43) | 5 (13) | 14 (44) | 0.007 |
Long-term oral steroids | 15 (15) | 5 (17) | 4 (11) | 6 (19) | 0.314 |
Biologic therapy | 13 (13) | 3 (10) | 2 (5) | 7 (22) | 0.030 |
Respiratory Data | |||||
Respiratory rate (per min) | 28 (20–34) | 29 (17–37) | 30 (25–35) | 24 (19–32) | 0.099 |
Heart rate (per min) | 112 (100–126) | 117 (102–130) | 114 (106–126) | 108 (94–123) | 0.274 |
Clinically exhausted | 70 (70) | 26 (87) | 28 (74) | 16 (50) | 0.001 |
Altered mental status | 29 (29) | 20 (67) | 8 (21) | 1 (3) | <0.001 |
pH | 7.37 (7.30–7.41) | 7.28 (7.21–7.36) | 7.38 (3.35–7.42) | 7.39 (7.36–7.43) | <0.001 |
PaO2/FiO2 ratio (mmHg) | 236 (155–313) | 209 (129–419) | 241 (158–314) | 245 (208–274) | 0.823 |
PaCO2 (mmHg) | 39 (33–47) | 53 (43–69) | 39 (35–45) | 33 (30–38) | <0.001 |
Bicarbonate (mmol/L) | 22.9 (19.9–25.9) | 24.7 (22.7–27.2) | 23.0 (19.9–26.6) | 20.5 (18.1–22.9) | <0.001 |
Base excess (mmol/L) | −2.7 (−4.7–−0.1) | −3.2 (−4.5–−0.6) | −1.8 (−4.9–0.3) | −3.5 (−5.1–−1.9) | 0.284 |
Lactate | 2.2 (0.9–4.4) | 1.2 (0.7–2.3) | 1.9 (0.9–3.8) | 4.2 (2.2–5.5) | 0.001 |
Microbiology Data | |||||
White cell count (×109/L) | 13.6 (10.4–18.6) | 17.3 (12.6–22.8) | 14.5 (10.9–17.0) | 11.5 (10.1–13.8) | 0.003 |
Neutrophil count (×109/L) | 11.7 (8.8–15.7) | 14.4 (10.8–19.0) | 12.0 (8.8–14.9) | 10.0 (8.7–12.1) | 0.022 |
Lymphocyte count (×109/L) | 0.8 (0.6–1.3) | 1.0 (0.6–1.4) | 0.8 (0.6–1.1) | 0.7 (0.6–1.2) | 0.636 |
NLR | 14.0 (7.8–23.4) | 13.8 (7.3–31.6) | 14.8 (9.0–23.5) | 12.9 (7.3–17.9) | 0.593 |
CRP (mg/L) | 22 (8–77) | 25 (11–82) | 41 (9–96) | 11 (5–27) | 0.028 |
Proven viral infection | 18 (18) | 6 (20) | 9 (24) | 3 (9) | 0.112 |
Proven bacterial infection | 8 (8) | 6 (20) | 2 (5) | 0 (0) | 0.003 |
Patient Outcomes | |||||
ICU length of stay (days) | 2.3 (1.3–4.4) | 5.1 (2.5–9.4) | 2.6 (1.4–3.4) | 1.3 (0.8–1.8) | <0.001 |
ECMO/ECCO2R | 2 (2) | 2 (6) | 0 (0) | 0 (0) | 0.029 |
In-ICU mortality | 1 (1) | 1 (3) | 0 (0) | 0 (0) | 0.125 |
Twenty-eight-day mortality | 1 (1) | 1 (3) | 0 (0) | 0 (0) | 0.125 |
Predictor Variable | Univariate OR (95% CI, p) | AUC (95% CI, p) |
---|---|---|
Respiratory rate | 1.01 (0.97–1.06, 0.637) | 0.513 (0.370–0.657, 0.855) |
Heart rate | 1.01 (0.99–1.03, 0.595) | 0.539 (0.406–0.67, 0.569) |
Exhaustion | 3.84 (1.21–12.24, 0.023) | 0.619 (0.505–0.733, 0.041) |
Altered mental status | 13.56 (4.83–38.06, <0.001) | 0.769 (0.658–0.880, <0.001) |
pH (per 0.1) | 0.33 (0.19–0.56, <0.001) | 0.772 (0.676–0.851, <0.001) |
PaCO2 (mmHg) | 1.08 (1.04–1.13, <0.001) | 0.809 (0.705–0.914, <0.001) |
PaO2/FiO2 ratio | 1.00 (0.99–1.00, 0.186) | 0.460 (0.316–0.604, 0.584) |
Lactate (mmol/L) | 0.71 (0.55–0.92, 0.011) | 0.676 (0.574–0.768, 0.002) |
WCC (×109/L) | 1.14 (1.05–1.23, 0.001) | 0.689 (0.569–0.810, 0.002) |
CRP (mg/L) | 1.00 (0.99–1.01, 0.254) | 0.558 (0.430–0.686, 0.375) |
Viral infection | 1.21 (0.41–3.59, 0.734) | 0.514 (0.389–0.639, 0.823) |
Bacterial infection | 8.50 (1.61–45.00, 0.012) | 0.586 (0.457–0.714, 0.192) |
All Patients (n = 100) | Invasive Mechanical Ventilation (n = 30) | Non-Invasive Respiratory Support (n = 38) | No Respiratory Support (n = 32) | p | |
---|---|---|---|---|---|
Pharmacological Treatment | |||||
Nebulised Bronchodilators | 100 (100) | 100 (100) | 100 (100) | 100 (100) | 1.000 |
Corticosteroids | 95 (95) | 29 (97) | 36 (95) | 30 (94) | 0.593 |
Antibiotics | 64 (64) | 23 (77) | 26 (68) | 14 (44) | 0.005 |
Mucolytics | 27 (27) | 16 (53) | 8 (21) | 3 (9) | <0.001 |
IV Magnesium | 96 (96) | 30 (100) | 35 (92) | 30 (94) | 0.125 |
IV Aminophylline | 62 (62) | 24 (80) | 23 (61) | 15 (49) | 0.007 |
IV Salbutamol | 28 (28) | 13 (43) | 6 (16) | 9 (28) | 0.012 |
IV Adrenaline | 21 (21) | 17 (57) | 2 (5) | 2 (6) | <0.001 |
IV Ketamine | 20 (20) | 17 (57) | 1 (3) | 2 (6) | <0.001 |
Inhaled Isoflurane | 4 (4) | 4 (13) | 0 (0) | 0 (0) | 0.002 |
First Respiratory Support | |||||
HFNO | 23 (23) | 6 (20) | 17 (45) | 0 (0) | <0.001 |
CPAP | 4 (4) | 1 (3) | 3 (8) | 0 (0) | 0.090 |
NIV | 24 (24) | 6 (20) | 18 (47) | 0 (0) | <0.001 |
IMV | 17 (17) | 17 (57) | 0 (0) | 0 (0) | <0.001 |
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Watson, A.J.R.; Roe, T.; Arscott, O.; Thomas, C.; Ward, J.; Beecham, R.; Browning, D.; Saeed, K.; Dushianthan, A. Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care. Clin. Pract. 2024, 14, 1886-1897. https://doi.org/10.3390/clinpract14050149
Watson AJR, Roe T, Arscott O, Thomas C, Ward J, Beecham R, Browning D, Saeed K, Dushianthan A. Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care. Clinics and Practice. 2024; 14(5):1886-1897. https://doi.org/10.3390/clinpract14050149
Chicago/Turabian StyleWatson, Adam J. R., Thomas Roe, Oliver Arscott, Charlotte Thomas, James Ward, Ryan Beecham, David Browning, Kordo Saeed, and Ahilanandan Dushianthan. 2024. "Characteristics, Management, and Outcomes of Acute Life-Threatening Asthma in Adult Intensive Care" Clinics and Practice 14, no. 5: 1886-1897. https://doi.org/10.3390/clinpract14050149