Trends in Management of Status Asthmaticus in a Community Hospital Pediatric ICU: 2014 - 2024

Introduction: Management strategies for pediatric status asthmatics (SA) have improved, with greater emphasis on non-invasive ventilation (NIV) support over the past decade. Studies show nationally decreased intubation rates due to increased utilization of non-invasive respiratory support therapies. There is limited data on management trends in a community hospital setting. Our objective is to evaluate management trends in a community hospital PICU setting.


Methods: This is a retrospective chart analysis of patients aged 2-18 years admitted with a diagnosis of SA between January 2014 and December 2024. Data extracted from EMR system using ICD codes for SA. Data collected included demographics, presenting symptoms and signs, lab and imaging data, associated diagnoses, and treatment modalities. Data was analyzed using SPSS for Windows version 28. We analyzed trends in the use of medications and respiratory support. Chi-square analysis was performed to compare categorical variables.


Results: There were 398 patients admitted to the PICU with SA during the study period. Boys had a greater rate (59.8%) of admission, and the predominant age group was 2-5 years old (46%). Over the 10-year period, the use of HFNC increased from 4.3% to 55% and the use of BIPAP also increased from 2.1% to 30%. Four patients required mechanical ventilation during the 2014-2019 period and zero in the 2020-2024 period. There was no identifiable trend in the use of epinephrine, Magnesium sulphate, and steroids.


Conclusions: There is an increased use of non-invasive respiratory support at our community hospital's PICU, consistent with national trends. There is a significant increase in the use of HFNC and BIPAP over the 10-year period. There are no significant trends identified in the medical management. These findings indicate that community hospital PICUs are keeping up with current trends in the management of status asthmaticus.