Krebs Steven E, Flood Robert G, Peter John R, Gerard James M
Division of Pediatric Emergency Medicine, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA.
Pediatr Emerg Care. 2013 Feb;29(2):191-6. doi: 10.1097/PEC.0b013e3182809b48.
This study aimed to assess the safety and efficacy of a high-dose continuous nebulized albuterol (CNA) protocol for treatment of asthma in the pediatric emergency department (ED). A secondary objective included a cost-benefit analysis of protocol use.
In this retrospective chart review, we compared cohorts of patients treated in our ED for acute asthma exacerbation before and after implementation of a CNA protocol. Patients between the ages of 2 and 21 years seen between March 1 and May 31, 2008 (preprotocol, n = 393), and March 1 to May 31, 2009 (postprotocol, n = 373), were included. Safety data included medication-related adverse effects as well as serum potassium and glucose levels. Efficacy data included ED length of stay, disposition, return visits, time to first albuterol treatment, and corticosteroid administration. Cost analysis included the cost of medications and respiratory therapy time.
Postprotocol patients more often received CNA (57.9% vs 25.2%, P < 0.01). No significant adverse effects, including tachyarrhythmia and symptomatic hypokalemia, were found in either group. Serum potassium levels were higher in the postprotocol group (3.9 mEq/L [n = 34] vs 3.5 mEq/L [n = 28], P < 0.01). Emergency department stay was longer in the postprotocol group (217.8 minutes vs 187.2 minutes, P < 0.01). Emergency department disposition was similar in both groups. The mean cost per patient was higher in the postprotocol group ($327.21 vs $277.95, P < 0.01).
We found the CNA protocol to be safe. Superior efficacy to a traditional treatment approach was not demonstrated. The mean cost of treatment was higher in the postprotocol group. Further prospective studies should be conducted to confirm the findings of this retrospective, observational study.
本研究旨在评估高剂量持续雾化沙丁胺醇（CNA）方案治疗儿科急诊科（ED）哮喘的安全性和有效性。次要目的包括对该方案使用的成本效益分析。
在这项回顾性图表审查中，我们比较了在实施CNA方案前后在我们急诊科接受急性哮喘加重治疗的患者队列。纳入了2008年3月1日至5月31日（方案实施前，n = 393）和2009年3月1日至5月31日（方案实施后，n = 373）期间就诊的2至21岁患者。安全性数据包括药物相关不良反应以及血清钾和葡萄糖水平。有效性数据包括急诊科住院时间、处置方式、复诊情况、首次沙丁胺醇治疗时间和皮质类固醇给药情况。成本分析包括药物成本和呼吸治疗时间。
方案实施后患者更常接受CNA治疗（57.9%对25.2%，P < 0.01）。两组均未发现明显不良反应，包括快速性心律失常和症状性低钾血症。方案实施后组的血清钾水平更高（3.9 mEq/L [n = 34]对3.5 mEq/L [n = 28]，P < 0.01）。方案实施后组的急诊科住院时间更长（217.8分钟对187.2分钟，P < 0.01）。两组的急诊科处置方式相似。方案实施后组每位患者的平均成本更高（327.21美元对277.95美元，P < 0.01）。
我们发现CNA方案是安全的。未证明其疗效优于传统治疗方法。方案实施后组的平均治疗成本更高。应进行进一步的前瞻性研究以证实这项回顾性观察性研究的结果。
