OBJECTIVE: Significant changes have occurred in the intensity of treatment of @entity1 with severe @entity565 in the last decade. The objectives of this study are 1) to describe the changes in treatment of asthmatic @entity1 needing care in the intensive care unit (ICU) initially treated in our @entity341 ( @entity341 ) in 1983 to 1985 (I) and in 1990 to 1992 (II), and 2) to examine if these changes correspond to changes in clinical outcomes. DESIGN: Retrospective descriptive study. @entity1 : All asthmatic @entity1 less than 18 years old treated in the @entity341 and admitted to the ICU directly or via the ward with a primary diagnosis of @entity565 . SETTING: Pediatric tertiary care hospital. RESULTS: A total of 89 ICU admissions were required for @entity1 initially treated in our @entity341 , 54 in 1983 to 1985 and 35 in 1990 to 1992. In 1985, 29.7% of @entity565 @entity1 required hospital admission and 0.5% needed ICU admission, while 30.7 and 0.7% required hospital and ICU admission, respectively, in 1992. Admissions to the ICU directly via the @entity341 were similar in both time periods (I, 27; II, 30), while those admitted to the ICU via the ward decreased significantly (I, 27; II, 5; P < 0.01). Recently, while in the @entity341 , these ICU @entity1 , on average, were treated with < or =q1h @entity3045 inhalations longer (I, 1.7 hours; II, 3.4 hours; P < 0.001), more frequently (I, 1.8 inhalations/h; II, 3.3 inhalations/h; P < 0.001), and with greater dosages (I, 0.20 mg/kg/h; II, 0.55 mg/kg/h; P < 0.001), than previously. Only 72% of @entity1 in 1983 to 1985 received i.v. @entity230 in the @entity341 versus 100% in 1990 to 1992. Ward @entity1 in 1990 to 1992 received < or =q1h inhalations for a greater proportion of their ward stay (I, 6.9/14.7 hours = 47%; II, 9.2/9.2 hours = 100%). There was a recent trend toward longer ICU treatment with < or =q1h @entity3045 inhalations (I, 8.7 hours; II, 12.3 hours; P = 0.24) and with i.v. @entity3045 (I, 29.4 hours; II, 37.4 hours; P = 0.26). Ventilation rates were low (I, 5/54 = 9.3%; II, 2/35 = 5.7%; P = NS) and the average duration of ICU stay remained unchanged (I, 40.6 hours; II, 42.1 hours; P = NS). CONCLUSIONS: Despite recent dramatic @entity341 and ward treatment changes, ICU admission rates for pediatric @entity565 remain relatively constant. However, intensive treatment may have contributed to the decrease in ICU admissions via the @entity341 to ward route in slightly less critical cases.

Changes in treatment and outcomes of @entity1 receiving care in the intensive care unit for severe acute XXXX .

@entity1 :: ('9606', 'Species') :: ['children', 'patients', 'PATIENTS'] @entity565 :: ('MESH:D001249', 'Disease') :: ['asthma'] @entity341 :: ('MESH:D004630', 'Disease') :: ['emergency department', 'ED'] @entity3045 :: ('MESH:D000420', 'Chemical') :: ['albuterol'] @entity230 :: ('MESH:D013256', 'Chemical') :: ['steroids']
@entity565 :: (MESH:D001249,Disease) :: ['asthma']
