Volatile anesthetic rescue therapy in children with acute asthma: Innovative but costly or just costly?

Danton S. Char, Laura Ibsen, Chandra Ramamoorthy, Susan L. Bratton

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives: To describe volatile anesthesia (VA) use for pediatric asthma, including complications and outcomes. Design: Retrospective cohort study. Setting: Children's hospitals contributing to the Pediatric Health Information System between 2004-2008. Patients: Children 2-18 years old with a primary diagnosis code for asthma supported with mechanical ventilation. Intervention: Those treated with VA were compared to those not treated with VA or extracorporeal membrane oxygenation. Hospital VA use was grouped as none, 10% among intubated children. Measurements and main results: One thousand five hundred and fifty-eight patients received mechanical ventilation at 40 hospitals for asthma: 47 (3%) received VA treatment at 11 (28%) hospitals. Those receiving a VA were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA. Length of mechanical ventilation, hospital stay (length of stay [LOS]) and charges were significantly greater for those treated with VA. Aspiration was more common but death and air leak did not differ. Patients at hospitals with VA use >10% were significantly less likely to receive inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but more likely to receive systemic b agonist, neuromuscular blocking agents compared to those treated at hospitals not using VA. LOS, duration of ventilation, and hospital charges were significantly greater for patients treated at centers with high VA use. Conclusions: Mortality does not differ between centers that use VA or not. Patients treated at centers with high VA use had significantly increased hospital charges and increased LOS.

Original languageEnglish (US)
Pages (from-to)343-350
Number of pages8
JournalPediatric Critical Care Medicine
Volume14
Issue number4
DOIs
StatePublished - May 2013

Fingerprint

Anesthetics
Asthma
Anesthesia
Therapeutics
Length of Stay
Artificial Respiration
Ipratropium
Neuromuscular Blocking Agents
Hospital Charges
Pediatrics
Health Information Systems
Extracorporeal Membrane Oxygenation
Ventilation
Cohort Studies
Retrospective Studies
Air
Mortality

Keywords

  • Asthma
  • Rescue therapy
  • Status asthmaticus
  • Volatile (inhalational) anesthetics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Volatile anesthetic rescue therapy in children with acute asthma : Innovative but costly or just costly? / Char, Danton S.; Ibsen, Laura; Ramamoorthy, Chandra; Bratton, Susan L.

In: Pediatric Critical Care Medicine, Vol. 14, No. 4, 05.2013, p. 343-350.

Research output: Contribution to journalArticle

Char, Danton S. ; Ibsen, Laura ; Ramamoorthy, Chandra ; Bratton, Susan L. / Volatile anesthetic rescue therapy in children with acute asthma : Innovative but costly or just costly?. In: Pediatric Critical Care Medicine. 2013 ; Vol. 14, No. 4. pp. 343-350.
@article{ef13cfb486ae4fc6bd1ead677d17cb87,
title = "Volatile anesthetic rescue therapy in children with acute asthma: Innovative but costly or just costly?",
abstract = "Objectives: To describe volatile anesthesia (VA) use for pediatric asthma, including complications and outcomes. Design: Retrospective cohort study. Setting: Children's hospitals contributing to the Pediatric Health Information System between 2004-2008. Patients: Children 2-18 years old with a primary diagnosis code for asthma supported with mechanical ventilation. Intervention: Those treated with VA were compared to those not treated with VA or extracorporeal membrane oxygenation. Hospital VA use was grouped as none, 10{\%} among intubated children. Measurements and main results: One thousand five hundred and fifty-eight patients received mechanical ventilation at 40 hospitals for asthma: 47 (3{\%}) received VA treatment at 11 (28{\%}) hospitals. Those receiving a VA were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA. Length of mechanical ventilation, hospital stay (length of stay [LOS]) and charges were significantly greater for those treated with VA. Aspiration was more common but death and air leak did not differ. Patients at hospitals with VA use >10{\%} were significantly less likely to receive inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but more likely to receive systemic b agonist, neuromuscular blocking agents compared to those treated at hospitals not using VA. LOS, duration of ventilation, and hospital charges were significantly greater for patients treated at centers with high VA use. Conclusions: Mortality does not differ between centers that use VA or not. Patients treated at centers with high VA use had significantly increased hospital charges and increased LOS.",
keywords = "Asthma, Rescue therapy, Status asthmaticus, Volatile (inhalational) anesthetics",
author = "Char, {Danton S.} and Laura Ibsen and Chandra Ramamoorthy and Bratton, {Susan L.}",
year = "2013",
month = "5",
doi = "10.1097/PCC.0b013e3182772e29",
language = "English (US)",
volume = "14",
pages = "343--350",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Volatile anesthetic rescue therapy in children with acute asthma

T2 - Innovative but costly or just costly?

AU - Char, Danton S.

AU - Ibsen, Laura

AU - Ramamoorthy, Chandra

AU - Bratton, Susan L.

PY - 2013/5

Y1 - 2013/5

N2 - Objectives: To describe volatile anesthesia (VA) use for pediatric asthma, including complications and outcomes. Design: Retrospective cohort study. Setting: Children's hospitals contributing to the Pediatric Health Information System between 2004-2008. Patients: Children 2-18 years old with a primary diagnosis code for asthma supported with mechanical ventilation. Intervention: Those treated with VA were compared to those not treated with VA or extracorporeal membrane oxygenation. Hospital VA use was grouped as none, 10% among intubated children. Measurements and main results: One thousand five hundred and fifty-eight patients received mechanical ventilation at 40 hospitals for asthma: 47 (3%) received VA treatment at 11 (28%) hospitals. Those receiving a VA were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA. Length of mechanical ventilation, hospital stay (length of stay [LOS]) and charges were significantly greater for those treated with VA. Aspiration was more common but death and air leak did not differ. Patients at hospitals with VA use >10% were significantly less likely to receive inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but more likely to receive systemic b agonist, neuromuscular blocking agents compared to those treated at hospitals not using VA. LOS, duration of ventilation, and hospital charges were significantly greater for patients treated at centers with high VA use. Conclusions: Mortality does not differ between centers that use VA or not. Patients treated at centers with high VA use had significantly increased hospital charges and increased LOS.

AB - Objectives: To describe volatile anesthesia (VA) use for pediatric asthma, including complications and outcomes. Design: Retrospective cohort study. Setting: Children's hospitals contributing to the Pediatric Health Information System between 2004-2008. Patients: Children 2-18 years old with a primary diagnosis code for asthma supported with mechanical ventilation. Intervention: Those treated with VA were compared to those not treated with VA or extracorporeal membrane oxygenation. Hospital VA use was grouped as none, 10% among intubated children. Measurements and main results: One thousand five hundred and fifty-eight patients received mechanical ventilation at 40 hospitals for asthma: 47 (3%) received VA treatment at 11 (28%) hospitals. Those receiving a VA were significantly less likely to receive inhaled b-agonists, ipratropium bromide, and heliox, but more likely to receive neuromuscular blocking agents than patients treated without VA. Length of mechanical ventilation, hospital stay (length of stay [LOS]) and charges were significantly greater for those treated with VA. Aspiration was more common but death and air leak did not differ. Patients at hospitals with VA use >10% were significantly less likely to receive inhaled b agonist, ipratropium bromide, methylxanthines, and heliox, but more likely to receive systemic b agonist, neuromuscular blocking agents compared to those treated at hospitals not using VA. LOS, duration of ventilation, and hospital charges were significantly greater for patients treated at centers with high VA use. Conclusions: Mortality does not differ between centers that use VA or not. Patients treated at centers with high VA use had significantly increased hospital charges and increased LOS.

KW - Asthma

KW - Rescue therapy

KW - Status asthmaticus

KW - Volatile (inhalational) anesthetics

UR - http://www.scopus.com/inward/record.url?scp=84877770838&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84877770838&partnerID=8YFLogxK

U2 - 10.1097/PCC.0b013e3182772e29

DO - 10.1097/PCC.0b013e3182772e29

M3 - Article

C2 - 23439466

AN - SCOPUS:84877770838

VL - 14

SP - 343

EP - 350

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 4

ER -