Prevalencia de asma casi fatal en la unidad de cuidados intensivos del Instituto Nacional de Enfermedades Respiratorias

Introduction: Asthma is a chronic inflammatory disease involving many different cell types and cellular elements. All patients with asthma are at risk of having exacerbations, which may range from mild to life-threatening. Near-fatal asthma (NFA) and fatal asthma represent the most severe clinical presentations of asthma. Patients with NFA usually require admission to an intensive care unit. The aim of this study was to determine the prevalence and clinical course of patients with NFA at a respiratory intensive care unit (RICU). Methods: Clinical records of patients admitted to the RICU from July 2005 to July 2008 with diagnosis of NFA were reviewed. Data collected included epidemiological characteristics, prior intubation, chest radiograph, initial arterial pH and PaCO2, length of RICU stay, and complications. Results: The prevalence of NFA in the study period was 2.3%. The group was integrated by 25 patients (7 males and 18 females), with a mean age of 32 years. A 40% of all patients had a history of hospital admission within the past year and 16% had already been at the RICU. Asthma severity was assessed using the GINA criteria: 9 (36%) patients were intermittent, 8 (32%) were mild-moderate persistent and 8 (32%) were severe persistent. The time of onset of the near-fatal event was sudden (< 6 hours) in 28%. Respiratory infections (76%) and non-steroid anti-inflammatory drugs (20%) were the principal causes of asthma attacks. Eighty perRESUMEN