Acute severe asthma requiring invasive mechanical ventilation in the era of modern resuscitation techniques: A 10-year bicentric retrospective study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
03
07
2020
accepted:
17
09
2020
entrez:
2
10
2020
pubmed:
3
10
2020
medline:
28
11
2020
Statut:
epublish
Résumé
Patients with acute severe asthma (ASA) may in rare cases require invasive mechanical ventilation (IMV). However, recent data on this issue are lacking. In this retrospective and bicentric study conducted on a 10 year period, we investigate the in-hospital mortality in patients with ASA requiring IMV. We compare this mortality to that of patients with other types of respiratory distress using a standardized mortality ratio (SMR) model. Eighty-one episodes of ASA requiring IMV were evaluated. Factors significantly associated with in-hospital mortality were cardiac arrest on day of admission, cardiac arrest as the reason for intubation, absence of decompensation risk factors, need for renal replacement therapy on day of admission, and intubation in pre-hospital setting. Non-survivors had higher SAPS II, SOFA, creatinine and lactate levels as well as lower blood pressure, pH, and HCO3 on day of admission. In-hospital mortality was 15% (n = 12). Compared to a reference population of 2,670 patients, the SMR relative to the SAPS II was very low at 0.48 (95% CI, 0.25-0.84). The only factor independently associated with in-hospital mortality was cardiac arrest on day of admission. In-hospital mortality was 69% in patients with cardiac arrest on day of admission and 4% in others (p < 0.01). Salvage therapies were given to 7 patients, sometimes in combination with each other: ECMO (n = 6), halogenated gas (n = 1) and anti-IL5 antibody (n = 1). Death occurred in only 2 of these 7 patients, both of whom had cardiac arrest on day of admission. Nowadays, the mortality of patients with ASA requiring IMV is low. Death is due to multi-organ failure, with cardiac arrest on day of admission being the most important risk factor. In patients who did not have cardiac arrest on day of admission the mortality is even lower (4%) which allows an aggressive management.
Identifiants
pubmed: 33007018
doi: 10.1371/journal.pone.0240063
pii: PONE-D-20-20581
pmc: PMC7531794
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0240063Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Chest. 2015 Jun;147(6):1671-1680
pubmed: 26033128
Am J Respir Crit Care Med. 2003 Oct 1;168(7):740-59
pubmed: 14522812
J Asthma. 2008 Sep;45(7):552-6
pubmed: 18773325
Crit Care. 2017 Dec 6;21(1):297
pubmed: 29212551
Ann Thorac Med. 2014 Jan;9(1):33-8
pubmed: 24551016
Clin Rev Allergy Immunol. 2012 Aug;43(1-2):30-44
pubmed: 21573915
PLoS One. 2014 Aug 20;9(8):e105347
pubmed: 25141011
Chest. 1994 Nov;106(5):1401-6
pubmed: 7956391
Ann Allergy Asthma Immunol. 2004 Jul;93(1):29-35
pubmed: 15281469
Crit Care Resusc. 2019 Mar;21(1):53-62
pubmed: 30857513
Intensive Care Med. 2016 May;42(5):712-724
pubmed: 27007108
Ann Intensive Care. 2019 Oct 10;9(1):115
pubmed: 31602529
Crit Care. 2004 Apr;8(2):R112-21
pubmed: 15025785
Allergy Asthma Proc. 2019 Nov 1;40(6):406-409
pubmed: 31690381
J Intensive Care Med. 2018 Sep;33(9):491-501
pubmed: 29105540
ASAIO J. 2009 Jan-Feb;55(1):47-52
pubmed: 19092662
Am J Respir Crit Care Med. 2014 Jun 1;189(11):1374-82
pubmed: 24693864
Ann Am Thorac Soc. 2014 Mar;11(3):404-6
pubmed: 24673696
Curr Drug Targets. 2009 Sep;10(9):826-32
pubmed: 19799536
BMC Public Health. 2019 May 30;19(1):663
pubmed: 31146713
Drugs. 2009;69(17):2363-91
pubmed: 19911854
Eur Respir J. 1996 Apr;9(4):687-95
pubmed: 8726932
Respir Care. 2014 May;59(5):644-53
pubmed: 24106317
Crit Care. 2009;13(2):R29
pubmed: 19254379
Lancet. 2017 Sep 2;390(10098):935-945
pubmed: 28797514
Ther Adv Respir Dis. 2018 Jan-Dec;12:1753466618808490
pubmed: 30354852
Rev Mal Respir. 2010 Feb;27(2):151-9
pubmed: 20206063
Respir Med Case Rep. 2019 Aug 22;28:100927
pubmed: 31485410
Am J Respir Crit Care Med. 2020 Jul 14;:
pubmed: 32663410
J Asthma. 2020 Apr;57(4):398-404
pubmed: 30701997
Eur J Clin Microbiol Infect Dis. 2017 Nov;36(11):1999-2006
pubmed: 27287765
Respir Res. 2019 Aug 8;20(1):179
pubmed: 31395084
Am J Respir Crit Care Med. 2006 Sep 15;174(6):633-8
pubmed: 16778163