PMID- 30857513 OWN - NLM STAT- MEDLINE DCOM- 20190528 LR - 20191210 IS - 1441-2772 (Print) IS - 1441-2772 (Linking) VI - 21 IP - 1 DP - 2019 Mar TI - Clinical management practices of life-threatening asthma: an audit of practices in intensive care. PG - 53-62 AB - 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. FAU - Secombe, Paul AU - Secombe P AD - Alice Springs Hospital, Alice Springs, NT, Australia. r.boots@uq.edu.au. FAU - Stewart, Penny AU - Stewart P AD - Alice Springs Hospital, Alice Springs, NT, Australia. FAU - Singh, Sunil AU - Singh S AD - Bundaberg Hospital, Bundaberg, QLD, Australia. FAU - Campbell, Lewis AU - Campbell L AD - Royal Darwin Hospital, Darwin, NT, Australia. FAU - Stephens, Dianne AU - Stephens D AD - Royal Darwin Hospital, Darwin, NT, Australia. FAU - Tran, Khoa AU - Tran K AD - Logan Hospital, Logan, QLD, Australia. FAU - White, Hayden AU - White H AD - Logan Hospital, Logan, QLD, Australia. FAU - Sheehy, Robert AU - Sheehy R AD - Logan Hospital, Logan, QLD, Australia. FAU - Gibson, Justine AU - Gibson J AD - Logan Hospital, Logan, QLD, Australia. FAU - Cooke, Robyn AU - Cooke R AD - Mater Adult Hospital, Brisbane, QLD, Australia. FAU - Townsend, Shane AU - Townsend S AD - Mater Adult Hospital, Brisbane, QLD, Australia. FAU - Apte, Yogesh AU - Apte Y AD - Robina Hospital, Gold Coast, QLD, Australia. FAU - Winearls, James AU - Winearls J AD - Gold Coast University Hospital, Gold Coast, QLD, Australia. FAU - Ferry, Olivia R AU - Ferry OR AD - Prince Charles Hospital, Brisbane, QLD, Australia. FAU - Pradhan, Rahul AU - Pradhan R AD - Prince Charles Hospital, Brisbane, QLD, Australia. FAU - Ziegenfuss, Marc AU - Ziegenfuss M AD - Prince Charles Hospital, Brisbane, QLD, Australia. FAU - Fong, Kwun M AU - Fong KM AD - Prince Charles Hospital, Brisbane, QLD, Australia. FAU - Yang, Ian A AU - Yang IA AD - Prince Charles Hospital, Brisbane, QLD, Australia. FAU - McGinnity, Paul AU - McGinnity P AD - Princess Alexandra Hospital, Brisbane, QLD, Australia. FAU - Meyer, Jason AU - Meyer J AD - Princess Alexandra Hospital, Brisbane, QLD, Australia. FAU - Walsham, James AU - Walsham J AD - Princess Alexandra Hospital, Brisbane, QLD, Australia. FAU - Boots, Rob AU - Boots R AD - University of Queensland, Brisbane, QLD, Australia. FAU - Clement, Pierre AU - Clement P AD - Royal Brisbane Hospital, Brisbane, QLD, Australia. FAU - Bandeshe, Hiran AU - Bandeshe H AD - Royal Brisbane Hospital, Brisbane, QLD, Australia. FAU - Gracie, Christopher AU - Gracie C AD - Royal Brisbane Hospital, Brisbane, QLD, Australia. FAU - Jarret, Paul AU - Jarret P AD - Royal Brisbane Hospital, Brisbane, QLD, Australia. FAU - Collins, Stephenie AU - Collins S AD - Royal Brisbane Hospital, Brisbane, QLD, Australia. FAU - Coulston, Caitlin AU - Coulston C AD - University of Queensland, Brisbane, QLD, Australia. FAU - Ng, Melisa AU - Ng M AD - University of Queensland, Brisbane, QLD, Australia. FAU - Howells, Valerie AU - Howells V AD - Royal Brisbane Hospital, Brisbane, QLD, Australia. FAU - Chatterjee, Indranil AU - Chatterjee I AD - Toowoomba Base Hospital, Toowoomba, QLD, Australia. FAU - Visser, Adam AU - Visser A AD - Toowoomba Base Hospital, Toowoomba, QLD, Australia. FAU - Smith, Judy AU - Smith J AD - Toowoomba Base Hospital, Toowoomba, QLD, Australia. FAU - Trout, Melita AU - Trout M AD - Townsville Hospital, Townsville, QLD, Australia. CN - Critical Care Asthma Investigators LA - eng PT - Journal Article PL - Netherlands TA - Crit Care Resusc JT - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine JID - 100888170 SB - IM MH - Adult MH - Asthma/*therapy MH - Australia MH - Critical Care MH - Female MH - Humans MH - *Intensive Care Units MH - Length of Stay MH - Medical Audit MH - Middle Aged MH - Outcome and Process Assessment, Health Care MH - Retrospective Studies EDAT- 2019/03/13 06:00 MHDA- 2019/05/29 06:00 CRDT- 2019/03/13 06:00 PHST- 2019/03/13 06:00 [entrez] PHST- 2019/03/13 06:00 [pubmed] PHST- 2019/05/29 06:00 [medline] PST - ppublish SO - Crit Care Resusc. 2019 Mar;21(1):53-62.