Critical Care
Critical Care 4
Nikhil Vallabhaneni, DO
Resident Physician
USF/Johns Hopkins All Children's Hospital
Tampa, Florida, United States
Macrolides, such as azithromycin (AZI), as adjunctive immunomodulation to systemic corticosteroids have been described for acute asthma exacerbation but not among critically ill children in the pediatric intensive care unit (PICU) referred to as critical asthma (CA).
Objective:
We aim to (1) characterize AZI prescribing rates and patterns among children hospitalized for CA and (2) assess for differences in clinical outcomes for those with and without AZI exposure (i.e., length of stay [LOS] and exposure rate to adjunctive therapeutic interventions).
Design/Methods:
We performed a single-center, retrospective cohort study at 268-Bed quaternary pediatric referral center from Oct 2020 through Dec 2022 including children 3-17 years of age hospitalized for CA without an alternative indication for AZI exposure. The primary outcome was AZI prescribing rate and descriptive features of encounters with and without exposure to AZI. Secondary outcomes were exploratory clinical outcomes including LOS, mortality, rate of invasive mechanical ventilation (IMV), and a composite rate of exposure to adjunctive CA therapies including pharmaceutical (i.e., terbutaline, ketamine, aminophylline) and respiratory (i.e., non-invasive ventilation, heliox, IMV, extracorporeal support, and volatile anesthetics) interventions. Statistics were descriptive (e.g., means, medians, and proportions) and comparative (e.g., Wilcoxon rank sum, student’s t, and Fisher’s exact testing).
Results:
A total of 228 patients met study criteria of whom 28 (12.2%) were prescribe AZI for CA during hospitalization. Compared to those without AZI exposure, those prescribed AZI were older (8.9 ± 3.9 vs 7 .6 ± 3.3, P < 0.001). No differences were detected in historic race, ethnicity categories, and adjunctive respiratory therapies for CA while in the PICU. Compared to those without AZI exposure, those with experienced a greater LOS (3.6 ± 1.4 vs 2.5 ± 1.3, P < 0.001) and comorbid exposure to CA adjunctive therapies (71.4% vs 31.7%, P < 0.001).
Conclusion(s):
In this single-center, retrospective cohort study, 12.2% of children hospitalized for CA were prescribed AZI for immunomodulation. Prescribing was more common among older children and those with more severe illness indicated by concurrent exposure to additional PICU-level CA therapies.