Characteristics and Outcomes of Paediatric Patients With Severe Acute Asthma in Retrieval.

AIM: To describe the characteristics, management, and outcomes of a paediatric cohort with severe acute asthma or wheeze retrieved to tertiary care.

METHODS

A retrospective cohort study of children ≥ 1 year old with severe acute asthma or wheeze retrieved to tertiary paediatric centres by a statewide paediatric retrieval service, January 2017 to May 2023. Data of clinical characteristics, pharmacotherapy, respiratory support, and outcomes were collected.

RESULTS

We included 325 patients, median age 6.8 years (IQR 3.8-10.5) and 61% male. High rates of nebulised bronchodilators, systemic corticosteroids, intravenous magnesium sulphate, and adjunct aminophylline use were observed. Ketamine was the preferred sedative agent among cases managed with mechanical or non-invasive ventilation. Intravenous salbutamol use declined significantly during the study (p = 0.04). Intubation rates were low (6.8%), non-invasive ventilation was the most common respiratory support (37.2%), and high-flow nasal cannula use increased over the study (p < 0.01). Overall, 65.5% of patients were admitted to intensive care. We report two deaths (0.9%) following intensive care admission and infrequent complications, including air leak (2.2%) and haemodynamic instability (2.8%). Variables associated with intensive care admission include pre-existing asthma diagnosis, preventer prescription, and previous intensive care admission (p < 0.05).

CONCLUSION

Contemporary severe acute asthma management frequently includes adjunct aminophylline and non-invasive ventilation. Clinical outcomes were overall good with short intensive care and hospital stays, low mortality rates, and infrequent complications. Children with pre-existing asthma diagnosis, preventer prescription, or prior PICU admission for asthma were more likely to require PICU care.