Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN.
Department of Pediatrics, Division of Pulmonology, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN.
Respir Care. 2019 Nov;64(11):1358-1365. doi: 10.4187/respcare.06447. Epub 2019 Mar 19.
Status asthmaticus is one of the most frequent admission diagnoses in the pediatric ICU (PICU). Collaboration between respiratory therapists (RTs) and physicians may help efficiently deliver care to a patient in status asthmaticus. The Pediatric Asthma Severity Score (PASS) is a measure of severity of a patient's asthma exacerbation at a point in time. The aim of this quality improvement initiative was to establish an RT-driven continuous albuterol weaning protocol using the PASS score. We hypothesized that this would decrease the duration of continuous albuterol without increasing adverse events.
This was a single-center implementation study in the PICU of a quaternary care children's hospital. Patients with a diagnosis of status asthmaticus who met criteria on continuous albuterol between September 2015 and September 2017 were included. An interdisciplinary team established the protocol, order sets, documentation, and education for involved staff. Qualifying subjects were assessed by an RT per protocol and assigned a PASS score, and the albuterol dose was adjusted on the basis of the PASS score.
We compared 104 subjects studied before the implementation of this protocol (September 2015 to August 2016) to 117 subjects after the implementation of this protocol (September 2016 to October 2017). Median (interquartile range) duration of continuous albuterol in the PICU post-implementation was unchanged compared to pre-implementation: 12.1 (7.2-21.0) h versus 11.1 (6-19) h ( = .22). Median PICU length of stay was also unchanged post-implementation compared to pre-implementation: 19.5 (14.3-29.7) h versus 23.2 (15.2-31.3) h ( = .16). Using control charts, these processes were stable. There was no difference in adverse events.
An interprofessionally-developed, RT-driven continuous albuterol weaning protocol can be implemented without negatively impacting duration of continuous albuterol or PICU length of stay and without increasing adverse events.
哮喘持续状态是儿科重症监护病房（PICU）最常见的入院诊断之一。呼吸治疗师（RTs）和医生之间的合作可能有助于有效地为哮喘持续状态患者提供护理。儿科哮喘严重程度评分（PASS）是衡量患者哮喘发作严重程度的一种即时测量方法。本质量改进计划的目的是建立一种基于 PASS 评分的 RT 驱动的持续沙丁胺醇逐渐减量方案。我们假设这将缩短持续沙丁胺醇的时间，而不会增加不良事件。
这是一家四级儿童医院 PICU 的单中心实施研究。纳入 2015 年 9 月至 2017 年 9 月期间符合持续沙丁胺醇使用标准的哮喘持续状态患者。一个跨学科团队制定了该方案、医嘱集、文件和培训计划。符合条件的患者由 RT 根据方案进行评估并进行 PASS 评分，然后根据 PASS 评分调整沙丁胺醇剂量。
我们将该方案实施前（2015 年 9 月至 2016 年 8 月）的 104 例患者与该方案实施后（2016 年 9 月至 2017 年 10 月）的 117 例患者进行了比较。实施后 ICU 内持续沙丁胺醇的中位（四分位距）时间与实施前相比无变化：12.1（7.2-21.0）h 与 11.1（6-19）h（ =.22）。实施后 ICU 住院时间与实施前相比也无变化：19.5（14.3-29.7）h 与 23.2（15.2-31.3）h（ =.16）。使用控制图，这些过程是稳定的。不良事件没有差异。
一个由跨专业人员开发的、由 RT 驱动的持续沙丁胺醇逐渐减量方案可以实施，而不会对持续沙丁胺醇时间或 ICU 住院时间产生负面影响，也不会增加不良事件。
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