A Retrospective Review of Children Admitted With Acute Severe Asthma to the Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital Between 2009 and 2019

Abstract

Aim: There is limited data on the PICU outcomes of children with acute severe asthma (ASA) in South Africa. This study aims to describe the profiles and treatment of all children admitted to our PICU with ASA. Methods: A retrospective audit of all children admitted with ASA to the PICU at Red Cross War Memorial Children's Hospital between 01 January 2009 and 31 December 2019. Results: There were 14 592 PICU admissions over the 11-year period, of which 180 admissions (1.2%) were for ASA. The median, interquartile range (IQR) age on admission was 67 (37–93) months. Almost all children received nebulisations, steroids and magnesium sulphate before PICU admission. Half of the patients were loaded with intravenous salbutamol (n = 96; 53.3%) and about a third (n = 61; 34%) received a salbutamol infusion before PICU admission. Similar proportions received nebulisations and steroids in PICU, 34 children (19%) received magnesium sulphate again in PICU and a total of 130 children (72.2%) received a salbutamol infusion. Most children received non-invasive respiratory support (n = 167; 90.3%), and 18 children (9.7%) required mechanical ventilation for a median (IQR) of 3 (2–4) days. The median PICU stay was 1 (IQR 1–2) day and median hospital stay was 4 (IQR 3–6) days. No children died. Conclusion: There has been an increasing number of children admitted to PICU with ASA over the 11-year period. There has been increased use of HFNC and the duration of PICU support is short.