Lowe Gary R, Willis J Randy, Bai Shasha, Heulitt Mark J
Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas.
Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Respir Care. 2017 Mar;62(3):259-267. doi: 10.4187/respcare.04857. Epub 2016 Dec 27.
Respiratory therapist (RT)-driven protocols have been in use for over 30 years. Protocols have been reported to decrease unnecessary or harmful therapy, health-care costs, and hospital stay. This study represents the evaluation of an original respiratory care protocol in the pediatric ICU at Arkansas Children's Hospital for β-agonist and airway clearance interventions where one did not exist.
This project was composed of 2 parts: a survey administered to RTs and licensed independent practitioners and a retrospective review of outcome data comparing a therapist-driven β-agonist/airway clearance protocol with physician-directed respiratory care ordering in a patient population admitted for acute respiratory failure.
Acceptance of the protocol was evident in the survey responses because overall perceptions surrounding the implementation of the β-agonist/airway clearance protocol were positive, and responders perceived that the protocol implementation elevated the status and increased the value of respiratory therapists. For the comparison of physician-directed orders with therapist-driven protocols, there were no significant differences between pre- and post-intervention groups for mean age, sex, mean daily acuity, or mean weighted daily acuity ( = .33, .19, >.99, and .79, respectively). There were also no differences in pediatric index of mortality 2, pediatric index of mortality 2 rate of mortality, pediatric risk of mortality 3 probability of death, and pediatric risk of mortality 3 scores ( = .63, .56, .19, and .44, respectively) between the 2 groups. When comparing physician-directed orders to therapist-driven protocols, all outcome measures (length of stay, β-agonist therapies, airway clearance therapies, and ventilator days) showed statistically and clinically important reductions, adjusting for subject characteristics ( < .001) for the therapist-driven protocol group.
In this institution, implementation of a β-agonist/airway clearance protocol resulted in significant reductions of subject interventions and improved outcomes by decreasing length of stay and ventilator days as well as contributing information where clinical evidence is scant, specifically the pediatric ICU.
呼吸治疗师（RT）驱动的方案已应用超过30年。据报道，这些方案可减少不必要或有害的治疗、医疗保健成本以及住院时间。本研究旨在评估阿肯色州儿童医院儿科重症监护病房（ICU）针对β受体激动剂和气道清理干预措施的一项原创呼吸护理方案，该病房此前尚无此类方案。
本项目由两部分组成：对呼吸治疗师和持牌独立从业者进行的一项调查，以及对急性呼吸衰竭入院患者群体中治疗师驱动的β受体激动剂/气道清理方案与医生主导的呼吸护理医嘱进行结果数据回顾性比较。
调查回复中明显体现了对该方案的接受，因为围绕β受体激动剂/气道清理方案实施的总体看法是积极的，且回复者认为该方案的实施提升了呼吸治疗师的地位并增加了其价值。对于医生主导的医嘱与治疗师驱动的方案进行比较，干预前和干预后组在平均年龄、性别、平均每日病情严重程度或平均加权每日病情严重程度方面无显著差异（分别为P = 0.33、0.19、>0.99和0.79）。两组在儿科死亡率指数2、儿科死亡率指数2死亡率、儿科死亡风险3死亡概率以及儿科死亡风险3评分方面也无差异（分别为P = 0.63、0.56、0.19和0.44）。在比较医生主导的医嘱与治疗师驱动的方案时，在调整了受试者特征后，所有结果指标（住院时间、β受体激动剂治疗、气道清理治疗和呼吸机使用天数）在治疗师驱动的方案组中均显示出统计学和临床上的显著降低（P < 0.001）。
在本机构中，实施β受体激动剂/气道清理方案通过缩短住院时间和减少呼吸机使用天数显著减少了受试者的干预措施，并改善了结果，同时在临床证据匮乏的情况下，特别是在儿科ICU提供了相关信息。
