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

Paul Secombe, Penny Stewart, Sunil Singh, Lewis Campbell, Dianne Stephens, Khoa Tran, Hayden White, Robert Sheehy, Justine Gibson, Robyn Cooke, Shane Townsend, Yogesh Apte, James Winearls, Olivia R Ferry, Rahul Pradhan, Marc Ziegenfuss, Kwun M Fong, Ian A Yang, Paul McGinnity, Jason Meyer, James Walsham, Rob Boots, Pierre Clement, Hiran Bandeshe, Christopher Gracie, Paul Jarret, Stephenie Collins, Caitlin Coulston, Melisa Ng, Valerie Howells, Indranil Chatterjee, Adam Visser, Judy Smith, Melita Trout
Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine 2019, 21 (1): 53-62

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.

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