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Improved outcomes from acute severe asthma in Australian intensive care units (1996–2003)
  1. Peter J Stow1,4,
  2. David Pilcher2,4,
  3. John Wilson3,
  4. Carol George4,
  5. Michael Bailey5,
  6. Tracey Higlett6,
  7. Rinaldo Bellomo4,7,
  8. Graeme K Hart4,7,
  9. and the Australian & New Zealand Intensive Care Society Adult Patient Database Management Committee
  1. 1Department of Intensive Care, Geelong Hospital, Geelong, Australia
  2. 2Department of Intensive Care, Alfred Hospital, Melbourne, Australia
  3. 3Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
  4. 4Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Database, Melbourne, Australia
  5. 5Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
  6. 6ANZICS Research Centre for Critical Care Resources, Melbourne, Australia
  7. 7Department of Intensive Care, Austin Hospital, Melbourne, Australia
  1. Correspondence to:
    Dr David Pilcher
    Intensive Care Unit, Alfred Hospital, Commercial Road, Prahran 3181, Victoria, Australia;d.pilcher{at}alfred.org.au

Abstract

Background: There is limited information on changes in the epidemiology and outcome of patients with asthma admitted to intensive care units (ICUs) in the last decade. A database sampling intensive care activity in hospitals throughout Australia offers the opportunity to examine these changes.

Methods: The Australian and New Zealand Intensive Care Society Adult Patient Database was examined for all patients with asthma admitted to ICUs from 1996 to 2003. Demographic, physiological and outcome information was obtained and analysed from 22 hospitals which had submitted data continuously over this period.

Results: ICU admissions with the primary diagnosis of asthma represented 1899 (1.5%) of 126 906 admissions during the 8-year period. 36.1% received mechanical ventilation during the first 24 h. The overall incidence of admission to ICU fell from 1.9% in 1996 to 1.1% in 2003 (p<0.001). Overall hospital mortality was 3.2%. There was a significant decline in mortality from a peak of 4.7% in 1997 to 1.1% in 2003 (p = 0.014). This was despite increasing severity of illness (as evidenced by an increasing predicted risk of death derived from the APACHE II score) over the 8-year period (p = 0.002).

Conclusions: There has been a significant decline in the incidence of asthma requiring ICU admission between 1996 and 2003 among units sampled by the Australian and New Zealand Intensive Care Society Adult Patient Database. The mortality of these patients has also decreased over time and is lower than reported in other studies.

  • ANZICS, Australian and New Zealand Intensive Care Society
  • APD, Adult Patient Database
  • COPD, chronic obstructive pulmonary disease
  • Fio2, fraction of inspired oxygen
  • ICU, intensive care unit
  • Pao2, Paco2, arterial oxygen and carbon dioxide tensions

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Footnotes

  • Published Online First 27 March 2007

  • Funding: None.

  • Competing interests: None.

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