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Respir Care. 2019 May 14. pii: respcare.06626. doi: 10.4187/respcare.06626. [Epub ahead of print]

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

Author information

1
Respiratory Care Services at Duke University Medical Center, Durham, North Carolina. andrew.g.miller@duke.edu.
2
Respiratory Care Services at Duke University Medical Center, Durham, North Carolina.
3
Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina.
4
Department of Pharmacy, Duke University Medical Center, Durham, North Carolina.
5
Division of Pediatric Hospital Medicine, Duke University Medical Center, Duke University Medical Center, Durham, North Carolina.

Abstract

BACKGROUND:

Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist- driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU.

METHODS:

We retrospectively reviewed the medical records of all pediatric asthma subjects 2-17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distributed data, and the Mann-Whitney test for nonparametric data.

RESULTS:

A total of 203 eligible subjects (49 in the pre-pathway group, 154 in the post group) were enrolled. There were no differences between groups for age, weight, gender, home medications, cause of exacerbation, medical history, or route of admission. There were significant decreases in median (interquartile range) hospital LOS (4.4 [2.9 - 6.6] d vs 2.7 [1.6 - 4.0] d, P < .001), median PICU LOS (2.1 [1.3- 4.0] d vs 1.6 [0.8 -2.4] d, P = .003), and median time on continuous albuterol (39 [25- 85] h vs 27 [13- 42] h, P = .001). Significantly more subjects in the post-pathway group were placed on high-flow nasal cannula (32% vs 6%, P = .001) or noninvasive ventilation (10% vs 4%, P = .02).

CONCLUSIONS:

The implementation of an asthma pathway was associated with decreased hospital LOS, PICU LOS, and time on continuous albuterol. There was also an increase in the use of high-flow nasal cannula and noninvasive ventilation after the implementation of this clinical pathway.

KEYWORDS:

asthma; asthma pathway; high-flow nasal cannula; propensity score matching; protocol; quality improvement; respiratory therapy; status asthmaticus

PMID:
31088987
DOI:
10.4187/respcare.06626

Conflict of interest statement

The authors have disclosed no conflicts of Interest.

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