High mortality seen in inner-city status asthmaticus patients

מתוך medicontext.co.il

NEW YORK (Reuters Health) – About 1 in 12 patients admitted to the medical intensive care unit of a Jacksonville hospital for status asthmaticus died before discharge, according to University of Florida researchers.

Dr. Bekele Afessa, who is currently at the Mayo Clinic, Rochester, Minnesota, and colleagues sought to characterize the clinical course, outcome, and other factors associated with ICU- treated status asthmaticus.

Accordingly, they analyzed data for 89 patients who had 132 such admissions over a 3-year period. The findings appeared in the November issue of Chest.

Overall, 67% of the patients were African American and 79% were women. In 36% of admissions, patients required invasive mechanical ventilation and in 13%, patients developed sepsis. Nonpulmonary organ failure developed during 12% of admissions and adult respiratory distress syndrome was seen in 2%. Four patients developed pneumothorax and all needed tube thoracostomy.

While all of the 11 deaths were among female patients, the difference in mortality between males and females was not statistically significant. However, the 8.3% mortality rate was higher than the 6.7% predicted by acute physiology and chronic health evaluation (APACHE) II scoring. The most common immediate causes of death were pneumothorax (3 patients), nosocomial infections (3 patients) and acute asthma (2 patients).

In comparison with survivors, those who died had higher APACHE II scores, arterial carbon dioxide tension (PaCO2) and lower arterial pH. Furthermore, 10 of the 39 patients who required invasive mechanical ventilation died.

These findings show an "unacceptably high" mortality rate, Dr. Afessa told Reuters Health. To decrease such mortality, "the public health system needs to develop an infrastructure to identify high risk patients and treat their chronic asthma appropriately before they deteriorate into status asthmaticus. Healthcare providers also need to adopt methods of ventilator support that will minimize the incidence of barotrauma and lung injury in patients with status asthmaticus."

In an accompanying editorial, Dr. Janet M. Shapiro of St. Luke's-Roosevelt Hospital, New York, calls the 21% mortality rate in intubated patients, "striking," noting that several series have shown rates of 6% or less.

The study, she adds, "reinforces the challenge to the pulmonary-critical care community to improve the entire spectrum of care–from the outpatient setting to the ICU–and thus enhance outcome in status asthmaticus."

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