在儿科 ICU 中实施重症哮喘方案。
Implementation of a Critical Asthma Protocol in a Pediatric ICU.
机构信息
Division of Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
Rocky Mountain Hospital for Children, Denver, Colorado.
出版信息
Respir Care. 2021 Apr;66(4):635-643. doi: 10.4187/respcare.07944. Epub 2021 Jan 27.
BACKGROUND
Protocol-driven therapy has been successful in managing patients with asthma on pediatric wards, but there is wide variability in ICU-level management that is often provider-dependent. This study aimed to determine if a standardized protocol for critical asthma treatment could improve clinical outcomes.
METHODS
A pre-intervention cohort consisting of subjects age 2-18 y, excluding patients with airway obstruction that was not felt to be due to asthma, who were admitted to the ICU for critical asthma. Demographics and data along with medication administration information were gathered using the hospital electronic medical record. A post-intervention cohort was obtained over 13 months in an identical manner. The primary end point was time on continuous albuterol. Subjects adhering to the protocol were examined as a subset.
RESULTS
71 post-intervention subjects were compared with a historical cohort of 52 pre-intervention subjects over a similar time frame. There were no significant differences in demographic characteristics. Median time on continuous albuterol (14.4 h vs 8.1 h, = .14) and secondary end points of median ICU length of stay (LOS), hospital LOS, and time from discontinuing continuous albuterol to transfer out of ICU were not significantly reduced in the post-intervention cohort. Overall adherence to the clinical protocol through completion was 42%. When comparing the pre-intervention cohort with the protocol-adherent subjects, significant reductions were seen in time on continuous albuterol (14.4 h vs 3.0 h, < .001), ICU LOS (38.7 h vs 21.0 h, < .001), and hospital LOS (2.8 d vs 1.7 d, = .005).
CONCLUSIONS
Implementation of an asthma protocol in the pediatric ICU did not result in significant improvements in time on continuous albuterol or hospital and pediatric ICU LOS, likely due to low adherence to the protocol. However, in subjects who did adhere to the protocol there were significant reductions in the outcome measures.
背景
在儿科病房，基于方案的治疗已成功用于管理哮喘患者，但 ICU 级别的管理存在很大差异，且往往依赖于治疗者。本研究旨在确定针对重症哮喘的标准化治疗方案是否能改善临床结局。
方法
在 ICU 接受重症哮喘治疗的 2-18 岁患者中，纳入非气道阻塞但非哮喘所致的患者，排除在外。收集人口统计学数据、用药信息，使用医院电子病历。以同样的方式在 13 个月的时间里获得干预后的队列。主要终点是持续使用沙丁胺醇的时间。对遵循方案的患者进行亚组检查。
结果
71 名干预后患者与类似时间框架内的 52 名干预前患者进行比较。人口统计学特征无显著差异。持续使用沙丁胺醇中位数时间（14.4 小时 vs 8.1 小时， =.14），次要终点 ICU 住院中位数时间（LOS）、住院 LOS、停止持续使用沙丁胺醇至转出 ICU 的时间均未显著缩短。临床方案整体完成率为 42%。将干预前队列与遵循方案的患者进行比较，持续使用沙丁胺醇时间（14.4 小时 vs 3.0 小时， <.001）、ICU LOS（38.7 小时 vs 21.0 小时， <.001）、住院 LOS（2.8 天 vs 1.7 天， =.005）显著减少。
结论
在儿科 ICU 实施哮喘方案并未显著缩短持续使用沙丁胺醇时间或减少医院和儿科 ICU LOS，可能是由于方案遵循率低。但是，在遵循方案的患者中，结局指标显著减少。
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