Standardized Protocol Is Associated With a Decrease in Continuous Albuterol Use and Length of Stay in Critical Status Asthmaticus*
| Autor: | Michael J. Pepin, Daniel Nachreiner, Denise Currier, Elliot Melendez, Michael S. D. Agus, Daria Donelly, Jackson Wong, Danielle Dwyer, Julie Hurlbut, D. Marlowe Miller |
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| Rok vydání: | 2020 |
| Předmět: |
Status Asthmaticus
Asthma severity Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Humans Medicine Weaning Albuterol Prospective Studies Child Prospective cohort study Adverse effect business.industry Critically ill 030208 emergency & critical care medicine Baseline data Length of Stay Bronchodilator Agents Child Preschool Anesthesia Pediatrics Perinatology and Child Health Female Observational study business Intermediate care |
| Zdroj: | Pediatric Critical Care Medicine. 21:451-460 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000002239 |
| Popis: | Objectives The primary aim of this study was to reduce duration of continuous albuterol and hospital length of stay in critically ill children with severe status asthmaticus. Design Observational prospective study from September 2012 to May 2016. Setting Medicine ICU and intermediate care unit. Patients Children greater than 2 years old with admission diagnosis of status asthmaticus admitted on continuous albuterol and managed via a standardized protocol. Interventions The protocol was an iterative algorithm for escalation and weaning of therapy. The algorithm underwent three revisions. Iteration 1 concentrated on reducing duration on continuous albuterol; iteration 2 concentrated on reducing hospital length of stay; and iteration 3 concentrated on reducing helium-oxygen delivered continuous albuterol. Balancing measures included adverse events and readmissions. Measurements and results Three-hundred eighty-five patients were treated as follows: 123, 138, and 124 in iterations 1, 2, and 3, respectively. Baseline data was gathered from an additional 150 patients prior to protocol implementation. There was no difference in median age (6 vs 8 vs 7 vs 7 yr; p = 0.130), asthma severity score (9 vs 9 vs 9 vs 9; p = 0.073), or female gender (42% vs 41% vs 43% vs 48%; p = 0.757). Using statistical process control charts, the mean duration on continuous albuterol decreased from 24.9 to 17.5 hours and the mean hospital length of stay decreased from 76 to 49 hours. There was no difference in adverse events (0% vs 1% vs 4% vs 0%; p = 0.054) nor in readmissions (0% vs 0% vs 1% vs 2%; p = 0.254). Conclusions Implementation of a quality improvement protocol in critically ill patients with status asthmaticus was associated with a decrease in continuous albuterol duration and hospital length of stay. |
| Databáze: | OpenAIRE |
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