Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas.
Department of Pediatrics, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas; and Pediatric Aerosol Research Laboratory, Arkansas Children's Research Institute, Little Rock, Arkansas.
Respir Care. 2022 Nov;67(11):1396-1404. doi: 10.4187/respcare.10083. Epub 2022 Aug 9.
Standardized acute asthma management with score-based, respiratory therapist (RT)-driven pathways and protocols improves outcomes including decreased length of stay (LOS) and time on continuous albuterol therapy. Limited data are available for the safety of continuous albuterol used outside of pediatric ICU (PICU). We use a modified pediatric asthma score (PAS) for the asthma pathway at our institution. The safety and effectiveness of using PAS to initiate/stop continuous albuterol as part of a score-based, RT-driven asthma pathway were evaluated.
A retrospective review of children ≥ 2 y admitted for asthma exacerbation to the PICU and step-down unit who received continuous albuterol as part of the asthma pathway during 2017-2019 was completed. Demographic and clinical data were extracted including PAS, dose and duration of continuous albuterol, LOS, and complications. Outcomes of subjects admitted to the PICU and step-down unit were compared.
Results are expressed as median (interquartile range). The study included 412 children (61% male, 59.9% Black, 92.7% non-Hispanic, 44.9% moderate persistent asthma) with age and weight of 6.4 (4.0-10.0) y and 24.8 (17.3-39.5) kg, respectively. Most children were admitted to step-down unit (71.1%). Initial albuterol dose, duration, and LOS were 15 (10-20) mg/h, 9.1 (5.7-16.0) h, and 1.4 (0.9-2.3) d, respectively. Respiratory support was required by 29% of subjects. Need to restart therapy (2.9%), transfer to PICU (1.7%), and intubation (0.5%) were infrequent. No pneumothoraces or deaths were reported. Emergency department visits (3.9%) or readmissions (0.7%) within 30 d of discharge were low. Subjects admitted to the PICU were sicker and required more therapies and respiratory support than those admitted to the step-down unit.
Use of an RT-driven, score-based pathway for initiation and discontinuation of continuous albuterol for treatment of pediatric asthma exacerbation was safe and effective in the PICU and step-down unit.
采用基于评分的、呼吸治疗师（RT）驱动的路径和方案进行标准化急性哮喘管理，可改善包括住院时间（LOS）和持续沙丁胺醇治疗时间在内的结局。关于在儿科重症监护病房（PICU）以外使用持续沙丁胺醇的安全性，数据有限。我们在机构中使用改良儿科哮喘评分（PAS）作为哮喘路径的一部分。评估了使用 PAS 启动/停止作为基于评分的 RT 驱动的哮喘路径的一部分的持续沙丁胺醇的安全性和有效性。
对 2017-2019 年期间因哮喘加重而入住 PICU 和降阶梯病房并接受哮喘路径中持续沙丁胺醇治疗的年龄≥2 岁的儿童进行回顾性研究。提取人口统计学和临床数据，包括 PAS、持续沙丁胺醇的剂量和持续时间、LOS 和并发症。比较入住 PICU 和降阶梯病房的患者的结局。
结果表示为中位数（四分位距）。研究包括 412 名儿童（61%为男性，59.9%为黑人，92.7%为非西班牙裔，44.9%为中度持续性哮喘），年龄为 6.4（4.0-10.0）岁，体重为 24.8（17.3-39.5）kg。大多数儿童入住降阶梯病房（71.1%）。初始沙丁胺醇剂量、持续时间和 LOS 分别为 15（10-20）mg/h、9.1（5.7-16.0）h 和 1.4（0.9-2.3）d。29%的患儿需要呼吸支持。需要重新开始治疗（2.9%）、转至 PICU（1.7%）和插管（0.5%）的比例较低。未报告气胸或死亡。出院后 30 天内急诊就诊（3.9%）或再入院（0.7%）的比例较低。入住 PICU 的患儿比入住降阶梯病房的患儿病情更重，需要更多的治疗和呼吸支持。
在 PICU 和降阶梯病房中，采用基于评分的、由 RT 驱动的路径启动和停止持续沙丁胺醇治疗儿童哮喘发作是安全有效的。
