Afessa B, Morales I, Cury J D
Division of Pulmonary and Critical Care, University of Florida Health Science Center, Jacksonville, FL, USA.
Chest. 2001 Nov;120(5):1616-21. doi: 10.1378/chest.120.5.1616.
To describe the prognostic factors, clinical course, and outcome of patients with status asthmaticus treated in a medical ICU (MICU).
Analysis of prospective data.
A multidisciplinary MICU of an inner-city university hospital.
We collected data on 132 hospital admissions of 89 patients with status asthmaticus treated in our MICU from August 1995 through July 1998.
APACHE (acute physiology and chronic health evaluation) II scores were among the parameters measured.
Seventy-nine percent of the patients were female, and 67% were African American (mean +/- SD age, 42.4 +/- 15.1 years). Patients in 48 of the 132 hospital admissions (36%) required invasive mechanical ventilation; sepsis developed in patients during 17 hospital admissions (13%), nonpulmonary organ failure developed during 16 hospital admissions (12%), and ARDS developed during 2 hospital admissions (2%). Pneumothorax developed in four patients and required tube thoracostomy in all four patients. The median APACHE II score was 11. Predicted mortality and actual mortality were 6.7% and 8.3%, respectively. The two most common immediate causes of death were pneumothorax (n = 3) and nosocomial infection (n = 3). All the deaths occurred in female patients. Compared with survivors, nonsurvivors had higher APACHE II scores (median, 26 vs 15; p < 0.0001), PaCO(2) (63.8 +/- 21.3 mm Hg vs 47.8 +/- 19.1 mm Hg, p = 0.0101), and lower arterial pH (7.09 +/- 0.12 vs 7.27 +/- 0.12, p < 0.0001), respectively. Patients in 10 of 48 hospital admissions (21%) who required mechanical ventilation died.
The hospital mortality of patients admitted to an MICU for status asthmaticus is higher than expected. Higher APACHE II score and PaCO(2) and lower arterial pH within 24 h of hospital admission are associated with increased mortality. Sepsis and nonpulmonary organ failure are more likely to develop in nonsurvivors than survivors.
描述在医学重症监护病房（MICU）接受治疗的哮喘持续状态患者的预后因素、临床病程及结局。
前瞻性数据分析。
市中心一所大学医院的多学科MICU。
我们收集了1995年8月至1998年7月在我院MICU接受治疗的89例哮喘持续状态患者132次住院的数据。
急性生理与慢性健康状况评价系统（APACHE）II评分是所测量的参数之一。
79%的患者为女性，67%为非裔美国人（平均±标准差年龄，42.4±15.1岁）。132次住院中的48次（36%）患者需要有创机械通气；17次住院（13%）患者发生脓毒症，16次住院（12%）患者发生非肺部器官衰竭，2次住院（2%）患者发生急性呼吸窘迫综合征（ARDS）。4例患者发生气胸，均需行胸腔闭式引流术。APACHE II评分中位数为11分。预测死亡率和实际死亡率分别为6.7%和8.3%。最常见的两个直接死亡原因是气胸（n = 3）和医院感染（n = 3）。所有死亡均发生在女性患者中。与幸存者相比，非幸存者的APACHE II评分更高（中位数，26对15；p < 0.0001）、动脉血二氧化碳分压（PaCO₂）更高（63.8±21.3 mmHg对47.8±19.1 mmHg，p = 0.0101）、动脉血pH值更低（7.09±0.12对7.27±0.12，p < 0.0001）。48次需要机械通气的住院中有10次（21%）患者死亡。
因哮喘持续状态入住MICU患者的医院死亡率高于预期。入院24小时内较高的APACHE II评分、PaCO₂及较低的动脉血pH值与死亡率增加相关。与幸存者相比，非幸存者更易发生脓毒症和非肺部器官衰竭。
