| Title: | Asthma exacerbations requiring ICU: patients more likely to have prior history of smoking and prior ICU admission. |
|---|---|
| Author(s): | C. Hayes, D. Long, RW Costello, DM Ryan |
| Institution: | Beaumont Hospital |
| Poster: | Click to view poster |
| Category: | Asthma and COPD |
| Abstract: | Asthma is a common condition affecting 1 in 12 people in Ireland.[1] Asthma exacerbation requiring ICU admission (AE-ICU) is associated with increased risk for asthma death.[2] Our aim was to audit pre-ICU management of patients with AE-ICU at Beaumont Hospital (BH) and identify areas for improvement. Medical records for AE-ICU to BH during 2014-2019 were reviewed regarding presentation and clinical course, timing and choice of treatments and imaging results. Patient care was compared to recognised standard of care (SOC) National Clinical Effectiveness Committee (2015) asthma guidelines.[1] There were 468 asthma admissions to BH with 15 (3.2%) AE-ICU. 11/15 (73%) were female. Mean age was 45.4 years (SD ± 17.2). 9/15 (60%) had history of smoking and 10/15 (67%) prior AE-ICU. 5/15 (33%) required mechanical ventilation. There were no asthma deaths. Median time to first nebuliser was 24 minutes (range 6-94) and to first steroid 25 minutes (range 6-553). Undocumented/inaccurate assessment of exacerbation severity (12/15) and inappropriate corticosteroid dose (12/15) were common. We conclude that AE-ICUs are infrequent at BH. Consistent with literature, we found prior smoking and AE-ICU history increase risk for future AE-ICU. Patients received early nebulisation but little PEFR monitoring. Excessive steroid dosing was common. References: 1. Department of Health. Management of an Acute Asthma Attack in Adults (NCEC National Clinical Guideline No. 14). Dublin: Department of Health, 2015. 2. Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Enquiry report. London: RCP, 2014. |
