Features of children with critical asthma hospitalized in a pediatric intensive care unit: Results from the ICU-3A study.

Abstract

Despite improvements in long-term asthma treatment, an increasing number of children are being hospitalized in pediatric intensive care units (PICU) for asthma. The main objective of this study was to describe a recent cohort of children hospitalized in PICU for asthma to identify risk factors associated with a need for respiratory support, and multiple PICU stays. We conducted a retrospective cohort study in three PICUs in Paris (intensive care units 3A Study), using medical files of children hospitalized for asthma between February 2019 and October 2020. Need for respiratory support was defined by the need for high-flow nasal cannula or mechanical ventilation (MV) (either noninvasive [NIV] or invasive [IMV]). During the study period, 252 stays corresponding to 234 patients were analyzed. MV was required in 17.5% of stays, for significantly younger patients (2.37 vs. 4.18 years, p = 0.002). On multivariate analysis, a higher risk of progression to a need for respiratory support was found for children requiring magnesium sulfate or oxygen therapy ≥6 L/mn before PICU admission (RR 4.48; CI95% [1.85-10.89]; p = 0.001, and RR 2.86; CI95% [1.13-7.22]; p = 0.03, respectively), and those with atelectasis detected on chest radiography (RR 3.38; CI95% [1.43-8.00]; p < 0.01). Multiple PICU stays were associated with greater social deprivation (RR for French Deprivation Index 1.25; CI95% [1.03-1.51]; p = 0.03). Children experiencing social deprivation are at greater risk of multiple PICU stays for severe asthma. After transfer to PICU, children with chest radiograph detected atelectasis on admission are at higher risk of needing respiratory support.