(1202) Taking a Deep Breath: Establishing Illness Severity in Children Intubated for Status Asthmaticus

Introduction: Asthma is one of the most common chronic diseases of childhood with high disease burden. While overall prevalence is decreasing, the number of pediatric intensive care unit (PICU) admissions for status asthmaticus has been rising. Invasive mechanical ventilation (IMV) use in management of status asthmaticus has been associated with long term morbidity and mortality. Our objective was to determine whether components of IMV course among patients with status asthmaticus are associated with increased risk of mortality, length of stay (LOS), or need for rescue therapies, such as need for inhaled anesthetics or extracorporeal membrane oxygenation (ECMO).

Methods: This is a retrospective observational study of patients older than two years admitted to our tertiary care PICU over 15 years (2008-2023) that were intubated for status asthmaticus. Demographics, comorbidities, LOS, laboratory data, and additional variables of each patient’s course were extracted from electronic medical records for analysis.

Results: 146 patients admitted to the PICU for status asthmaticus required IMV. Mortality was higher in patients 12-22 years old (p=0.033). There was a higher likelihood of survival when patients were intubated in the PICU as compared to in the emergency department (p=0.014). PICU and hospital LOS were longer in patients of Hispanic ethnicity (p < 0.001), age 2-5 years (p < 0.001), and those with medical complexity (p < 0.001). The presence of air leak and intubation in the PICU also led to longer LOS (p < 0.001). There was no difference in race/ethnicity, age, sex, location of intubation, presence of air leak, or presence of comorbidities in patients who did and did not require rescue therapies such as isoflurane or ECMO.

Conclusions: Both patient factors and hospital interventions are associated with mortality and PICU and hospital length of stay in patients who are intubated for status asthmaticus, although there is no association with need for advanced therapies. Next steps include comparing this population with the patients admitted to the PICU with status asthmaticus who do not require IMV to ultimately identify and prevent decompensation and poor outcomes in those patients who are at the highest risk.