Improved outcomes from acute severe asthma in Australian intensive care units (1996 – 2003)

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: We interrogated the Australian and New Zealand Intensive Care Society Adult Patient Database for all patients with asthma admitted to ICU 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 1,899 (1.5%) of 126,906 admissions during the 8 year period. 36.1% received mechanical ventilation during the first 24 hours. 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.