Abstract

GUIMARAES, Cátia et al. Critical asthma syndrome in a portuguese intensive care unit. Rev Port Imunoalergologia [online]. 2016, vol.24, n.3, pp.155-162. ISSN 0871-9721.

Introduction: critical asthma syndrome (CAS) needs emergency care, usually in intensive/intermediate care unit (ICU/ITCU). Objectives: characterization of patients admitted to the ICU/ITCU with the diagnosis of CAS. Methods: retrospective review of medical records of patients admitted with CAS, over a period of four years. Results: 18 patients were admitted with the diagnosis of CAS; 9 patients (50%) had severe asthma, and only once (5.6 %) was steroid dependent. Of the 11 patients admitted to the ICU the New Simplified Acute Physiology score was 35.5 ± 20.9, Acute Physiologic and Chronic Health Evaluation was 17.5 ± 9.2 and predicted mortality was 30.2% ± 34.8. Blood gas values at admission in emergency department: pH 7.19 ± 0.17, PaCO2 78.6 ± 33.7, PaO2 91.7 ± 60.8. At hospital discharge, there was a statistically significant increase in pH (7.42 ± 0.06, p = 0.001) and a statistically significant decreased in PaCO2 (41.3 ± 6.2, p=0,001). Cardiopulmonary arrest occurred in 4 patients (22.2 %), and was necessary endotracheal intubation in 12 patients (83.3% intubated in the first 24 hours). Propofol was the most commonly used sedative (11 patients); 2 patients were sedated with sevoflurane and one patient with ketamine. Three patients were curarized [longer length of stay (p=0.027) and more days under mechanical ventilation (p=0.009)]. Noninvasive ventilation was used in 4 patients (22.2 %). We only registered one death (5.6%). Conclusion: half patients had severe asthma criteria, which supports the need for hospitalization in ICU/ITCU. Although most patients required mechanical ventilation, the outcome was favorable, with significant blood gas improvement and low mortality rate.

Keywords : Asthma; critical asthma syndrome; respiratory failure; severe exacerbation, prognosis.

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