Implementing a Respiratory Therapist-Driven Continuous Albuterol Weaning Protocol in the Pediatric ICU.

Autor:	Maue DK; Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN. dmaue@iu.edu., Tori AJ; Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN., Beardsley AL; Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN., Krupp NL; Department of Pediatrics, Division of Pulmonology, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN., Hole AJ; Department of Respiratory Care Services, Riley Hospital for Children at Indiana University Health, Indianapolis, IN., Moser EA; Department of Biostatistics, Indiana University, Indianapolis, IN., Rowan CM; Department of Pediatrics, Division of Critical Care Medicine, Indiana University School of Medicine/Riley Hospital for Children at IU Health, Indianapolis, IN.
Jazyk:	angličtina
Zdroj:	Respiratory care [Respir Care] 2019 Nov; Vol. 64 (11), pp. 1358-1365. Date of Electronic Publication: 2019 Mar 19.
DOI:	10.4187/respcare.06447
Abstrakt:	Background: 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. Methods: 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. Results: 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 ( P = .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 ( P = .16). Using control charts, these processes were stable. There was no difference in adverse events. Conclusions: 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. Competing Interests: The authors have disclosed no conflicts of interest. (Copyright © 2019 by Daedalus Enterprises.)
Databáze:	MEDLINE
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