A ten - year study on in the intensive care unit of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan

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Date
2001-11
Authors
Ahmad, Rashidi
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Publisher
Universiti Sains Malaysia
Abstract
Acute exacerbation of severe asthma is a common presentation to the Emergency Department, hospital, and Intensive Care Unit admission. This study will review asthma patients that admitted into the intensive care unit of Hospital Universiti Sains Malaysia. By studying the demographic characteristics or patients' profile, and the precipitating factors, we can predict those asthmatics that will deteriorate or develop severe asthma symptoms. This is very important and essential to prevent the morbidity and mortality and to improve the outcome. The main objectives of this study are: 1. To analyze and identify the demographic characteristics of asthma patients that required admission into Intensive Care Unit. 2. ·To identify the common predisposing factors for severe asthma that required intensive care management 3. To identify the risk factors for severe asthma that admitted for mechanical ventilatory support. This is a 10-year observational study from 1999 to a 2000. All asthma cases that were admitted into Hospital University Science Malaysia Intensive Unit Care were included in the study. Variables on study were demographic characteristics, past medical history, allergic history, medications, and severity of illness, precipitating factors, compliance, complications, duration of stay, ventilation or observation and others. There were 103 asthma cases in this study. Predominate by female patients (60.2o/o). Age group between 30 to 34 years old had a highest ICU admission. Mean age was 33 years old. 76o/o of the subjects were non-smoking asthma patients. 61.2°/o of the subjects were self-referred, 77.3o/o had a positive family history of asthma, and 58.1o/o had moderate severity of chronic asthma. Precipitating factors were upper respiratory tract infection (51.5o/o) and .P~eumonia (28.2o/o). 74.8o/o of subjects had previous history of hospital admission and 36. 9o/o had previous history of ICU admission. 73o/o had a poor compliance to medication, and 79.8o/o had improper technique of using the inhaler. 35°/o of the subjects had hypokalaemia and 16.5o/o had a hypoxic fit. Other complications were pneumonia, arrythmias, and pneumothorax. 85°/o of subjects stayed less than 4 days in ICU. Majority of subjects responded to standard asthma therapy. The great challenge in managing acute asthma patients in ED is to prevent the recurrence of asthma attack, to decide whether the required admission or not, and to prevent mortality. Our data showed middle and old asthma patients, sudden onset of severe asthma, severe chronic asthma, poor compliance, poor inhaler technique, history of hospital admission and ICU admission were important risk factors for the develoment of acute severe asthma. Upper respiratory infections and pneumonia were common precipitating factors of acute severe asthma. Regarding the risk for ventilation we noted it has a significant correlation or association with age, severity of chronic asthma, history of hospitalization, and ICU admission. Number of ventilated patients was high in middle age group, severe chronic asthma, those with a history of hospitalization and ICU admission, and also in those poor compliance patients and those who can't perform the technique of inhalation properly. Majority of the patients that admitted into ICU responded to standard therapy. The complications were minimal. These patients usually recover very fast and majorities of them stayed just for a few days in ICU.
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Asthma
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