Messer Amanda F, Sampayo Esther M, Mothner Brent, Camp Elizabeth A, Jones Jennifer, Brown Terri, Vachani Joyee
Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, La.
Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
Pediatr Qual Saf. 2019 Dec 5;4(6):e225. doi: 10.1097/pq9.0000000000000225. eCollection 2019 Nov-Dec.
There are little data to support the use of continuous aerosolized albuterol (CAA) in the non-intensive care unit (ICU) or non-emergency department (ED) setting for pediatric asthma patients. A 2014 study demonstrated low rates of adverse outcomes associated with administration of CAA on the acute care unit; however, the authors do not describe additional outcomes. We sought to determine whether administration of CAA within a respiratory cohort on an acute care floor was feasible and safe.
This quasi-experimental study evaluates data 1 year before and after (2014-2016) the initiation of CAA on the acute care inpatient unit for asthma patients 2-18 years of age. Outcome measures included ED and hospital length of stay (LOS), readmission rate, rapid response team activations, and transfers to ICU. Use of chest x-rays, viral studies, and hospital charges were also studied.
Seven hundred thirty-two patients met study criteria. Population demographics and severity of acute presentation were similar pre- and poststudy. ED LOS decreased poststudy, whereas overall hospital LOS was unchanged. Fifteen-day readmission rate decreased in the poststudy group. Only 4 rapid response activations occurred in the poststudy population. The poststudy group utilized fewer chest x-rays and viral studies. There was no change in overall hospital charges.
With appropriate resources and safety processes in place, care of pediatric patients with status asthmaticus receiving CAA on an acute care unit, outside of the ICU, resulted in improved ED LOS with evidence of lower resource utilization and rare adverse outcomes.
几乎没有数据支持在非重症监护病房（ICU）或非急诊科（ED）环境中对儿科哮喘患者使用持续雾化沙丁胺醇（CAA）。一项2014年的研究表明，在急性护理病房使用CAA的不良后果发生率较低；然而，作者并未描述其他结果。我们试图确定在急性护理楼层的呼吸科队列中给予CAA是否可行且安全。
这项准实验性研究评估了2014 - 2016年在急性护理住院病房开始对2至18岁哮喘患者使用CAA之前和之后1年的数据。结果指标包括急诊科和住院时间（LOS）、再入院率、快速反应团队启动次数以及转至ICU的情况。还研究了胸部X光检查、病毒学检查的使用情况以及医院费用。
732名患者符合研究标准。研究前后的人群人口统计学特征和急性表现严重程度相似。研究后急诊科住院时间缩短，而总体住院时间未变。研究后组的15天再入院率降低。研究后人群中仅发生了4次快速反应启动。研究后组使用的胸部X光检查和病毒学检查较少。总体医院费用没有变化。
在具备适当资源和安全流程的情况下，在ICU以外的急性护理病房对患有哮喘持续状态的儿科患者进行CAA治疗，可改善急诊科住院时间，并有证据表明资源利用率降低且不良后果罕见。
