Chest
Volume 122, Issue 5, November 2002, Pages 1709-1714
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Clinical Investigations in Critical Care
Correlates of Prolonged Hospitalization in Inner-City ICU Patients Receiving Noninvasive and Invasive Positive Pressure Ventilation for Status Asthmaticus

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Study objectives

To describe the outcome of patients with status asthmaticus (SA) treated in a medical ICU with positive pressure ventilation (PPV), and to identify those factors associated with increased length of hospital stay.

Design

Retrospective chart review.

Setting

University-based hospital in Chicago, IL.

Patients

All patients admitted with SA and treated with PPV over a 5-year period.

Results

The first ICU admission for each of 78 patients was analyzed. Fifty-six patients underwent endotracheal intubation (ETI) during the hospitalization, while 22 patients were treated with noninvasive PPV alone. Three patients died. The median hospital length of stay was 5.5 days. Cox regression analysis revealed the following factors to be independently associated with increased length of hospital stay: female gender (p < 0.01), ETI (p < 0.01), the administration of neuromuscular blockers for > 24 h (p < 0.01), inhaled corticosteroid use prior to ICU admission (p = 0.01), and increasing APACHE (acute physiology and chronic health evaluation) II score (p < 0.01).

Conclusions

This study suggests that while the mortality associated with SA treated with contemporary methods of PPV is low, certain factors, including female gender, ETI, and the prolonged use of neuromuscular blockade, are associated with an increased length of hospital stay. The development of respiratory failure despite preadmission use of inhaled corticosteroids is also associated with prolonged hospitalization.

Section snippets

Patient Population

This study was approved by the Institutional Review Board at the University of Chicago Hospitals. Eligible subjects included all patients with SA who were treated in the medical ICU at the University of Chicago Hospitals between May 1995 and May 2000 with either endotracheal intubation (ETI) and mechanical ventilation, or a minimum of 2 consecutive h of noninvasive PPV (NIPPV). Subjects were identified after analyzing the medical records of patients admitted to the ICU and billed with

Results

Seventy-nine patients were admitted a total of 105 times to the University of Chicago Hospitals Medical ICU and treated with PPV. Seventy-eight charts were available for review.

Characteristics of the study population are shown in Table 1. Nearly all (96%) of the patients were African American, and 72% were female. Fewer than half (47%) were receiving inhaled corticosteroids on presentation, while 33% had been receiving systemic steroids for > 24 h. Thirty-one percent used tobacco, and at least

Discussion

In a mostly African-American population of patients receiving PPV for SA, we found an association between increased length of hospital stay and female gender, as well as with preadmission use of inhaled corticosteroids. Both ETI and the administration of neuromuscular blockers for > 24 h were also associated with longer hospitalizations.

One of the major findings of our study is the significantly longer length of stay for women compared with men (7.1 days vs 4.8 days), even after adjusting for

ACKNOWLEDGMENT

The authors thank Michael Woo, MD, for the identification of subjects in the study.

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  • Cited by (0)

    This work was performed at the University of Chicago.

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