Implementation of a Critical Asthma Protocol in a Pediatric ICU
| Autor: | Cynthia Davey, Nicholas M Kucher, Gwenyth Fischer, Danielle S Dhaliwal, Sameer Gupta |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Adolescent Status Asthmaticus Intensive Care Units Pediatric Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine medicine Clinical endpoint Humans Albuterol Child Original Research Retrospective Studies Asthma Protocol (science) business.industry Electronic medical record Retrospective cohort study General Medicine Length of Stay Airway obstruction medicine.disease Bronchodilator Agents respiratory tract diseases 030228 respiratory system Child Preschool Emergency medicine Cohort business Historical Cohort |
| Zdroj: | Respir Care |
| ISSN: | 1943-3654 0020-1324 |
| DOI: | 10.4187/respcare.07944 |
| Popis: | 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, P = .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, P < .001), ICU LOS (38.7 h vs 21.0 h, P < .001), and hospital LOS (2.8 d vs 1.7 d, P = .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. |
| Databáze: | OpenAIRE |
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