Volatile anesthetic rescue therapy in children with acute asthma: innovative but costly or just costly?

OBJECTIVES: To describe volatile anesthesia (VA) use for pediatric asthma, including complications and outcomes.

DESIGN: Retrospective cohort study.

SETTING: Children's hospitals contributing to the Pediatric Health Information System between 2004-2008.

PATIENTS: Children 2-18 years old with a primary diagnosis code for asthma supported with mechanical ventilation.

INTERVENTION: Those treated with VA were compared to those not treated with VA or extracorporeal membrane oxygenation. Hospital VA use was grouped as none, <5%, 5-10% and >10% among intubated children.

MEASUREMENTS AND MAIN RESULTS: One thousand five hundred and fifty-eight patients received mechanical ventilation at 40 hospitals for asthma: 47 (3%) received VA treatment at 11 (28%) hospitals. Those receiving a VA were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA. Length of mechanical ventilation, hospital stay (length of stay [LOS]) and charges were significantly greater for those treated with VA. Aspiration was more common but death and air leak did not differ. Patients at hospitals with VA use >10% were significantly less likely to receive inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but more likely to receive systemic b agonist, neuromuscular blocking agents compared to those treated at hospitals not using VA. LOS, duration of ventilation, and hospital charges were significantly greater for patients treated at centers with high VA use.

CONCLUSIONS: Mortality does not differ between centers that use VA or not. Patients treated at centers with high VA use had significantly increased hospital charges and increased LOS.