Practice Pattern Variation in Management of Severe Acute Asthma Among Mechanically Ventilated Patients in Pediatric Versus Adult ICUs

A large multicenter retrospective study was conducted to examine practice patterns in the care of severe acute asthma in PICUs compared with adult ICUs. Eligible patients were 12-26 y old, admitted to a PICU or an adult ICU with severe acute asthma, and received noninvasive ventilation or mechanical ventilation. Multiple medication prescribing practice patterns were examined. 3,361 total patients were included: 583 (17.3%) were admitted to PICUs and 2,778 (82.7%) were admitted to adult ICUs. Significantly more patients admitted to PICUs received parenteral terbutaline (25.7% vs. 10.2%, standard mean differences = 0.412) than those admitted to adult ICUs. Admission to PICUs for asthma was associated with a trend toward increased mortality, cardiac arrhythmias and duration of mechanical ventilation compared with adult ICUs. Further studies are needed to assess the safety and efficacy of parenteral terbutaline in adolescents and young adults; guidelines for the management of severe acute asthma in the ICU are needed.