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Research Snapshot Theater: Pulmonary, Pediatric III

Air Leak Syndrome in Pediatric Patients Intubated for Status Asthmaticus

Tuesday, March 24, 2026
11:15 AM - 12:15 PM Central Time
Location: Connections Central - RST 13
  • GP

    Gayathri Prabhakar, MD

    null
    null

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • ED

    Emily Davies, DO

    Attending Physician
    Chilren's National Hospital

    Disclosure information not submitted.

  • ET

    Eduardo Trujillo Rivera, PhD

    Faculty Data Scientist
    Children's National Hospital

    Disclosure information not submitted.

  • DR

    Deepa Rastogi, MD

    Division Chief, Pediatric Respiratory and Sleep Medicine
    Montefiore Einstein

    Disclosure information not submitted.

  • MS

    Matthew Sharron, MD

    PICU Medical Unit Director
    Children's National Hospital, District of Columbia

    Disclosure information not submitted.

Introduction: Invasive mechanical ventilation (IMV) in pediatric status asthmaticus has been associated with long term morbidity. Air leak syndrome (ALS), which includes pneumothorax, pneumomediastinum, or subcutaneous emphysema, is a rare but clinically challenging complication of status asthmaticus which has not been described on a large scale. Our objective was to describe ALS in patients treated with IMV for status asthmaticus and to determine the relationship between ALS and mortality and length of stay (LOS).


Methods: This is a retrospective observational study of patients older than 2 years requiring IMV for status asthmaticus at a tertiary urban PICU over 15 years (2008-2023). Demographics, comorbidities, LOS, laboratory data, and interventions provided were extracted from the electronic medical record. Univariate and multivariate analyses were performed for selected variables to compare patients who did and did not develop ALS.


Results: 146 patients admitted to the PICU for status asthmaticus required IMV, and 22 developed ALS. Median age of patients with ALS was 12.5 years. Patients aged 12-22 years had a higher percentage of developing ALS (p=0.016). ALS was detected in 8 patients prior to intubation, and 12 patients required intervention. There was no difference in sex, race, or location of intubation between those who did or did not develop ALS. Patients with ALS demonstrated worse lactatemia (5.8 vs 2.9, p< 0.001) and hypercarbia (91 vs 70, p< 0.001). Patients with ALS had a longer PICU and hospital LOS (PICU: 9.8 vs 4.8 days, p < 0.001, hospital:16.9 vs 8.7 days, p< 0.001). There was no difference in mortality between the two groups.


Conclusions: Adolescent patients with status asthmaticus requiring IMV are at higher risk of ALS than their younger counterparts. Critically ill children with status asthmaticus and ALS have worse markers of acidosis and have longer LOS than those who do not. However, there is no association between ALS and mortality. This may suggest that presence of ALS may serve as a marker of severity of illness in status asthmaticus. These findings may guide management towards minimizing barotrauma and anticipating protracted lengths of stay. Future directions include investigating whether specific interventions for status asthmaticus can reduce incidence of ALS.