Implementation of a critical asthma protocol in a pediatric icu

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)635-643
Number of pages9
JournalRespiratory care
Volume66
Issue number4
DOIs
StatePublished - Apr 1 2021

Bibliographical note

Funding Information:
This work was supported by National Institutes of Health?s National Center for Advancing Translational Sciences Grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health?s National Center for Advancing Translational Sciences.

Funding Information:
The authors have disclosed no conflicts of interest. This work was supported by National Institutes of Health’s National Center for Advancing Translational Sciences Grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences.

Publisher Copyright:
© 2021 Daedalus Enterprises.

Keywords

  • Albuterol
  • Asthma protocol
  • Critical pathways
  • Intensive care units
  • Length of stay
  • Pediatrics
  • Protocol
  • Status asthmaticus
  • Length of Stay
  • Humans
  • Bronchodilator Agents/therapeutic use
  • Child, Preschool
  • Status Asthmaticus/drug therapy
  • Intensive Care Units, Pediatric
  • Asthma/drug therapy
  • Albuterol/therapeutic use
  • Adolescent
  • Retrospective Studies
  • Child

PubMed: MeSH publication types

  • Journal Article

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