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Nikki Danner – Use of Continuous Albuterol in a Pathway for Treatment of Pediatric Acute Asthma

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In this video as part of the 2021 AARC Editor’s Choice Open Forum presentations, Nikki Danner presents – “Use of Continuous Albuterol in a Pathway for Treatment of Pediatric Acute Asthma”

Hi everyone my name is nikki danner and i would like to present our project the use of continuous albuterol in a pathway for treatment of pediatric acute asthma exacerbation respiratory therapist driven protocols help to standardize and improve quality of care we use an rt driven score based asthma pathway for children ages 2 and older admitted to the hospital

For acute asthma the pathway uses a modified pediatric asthma score and provides guidance for treatment including continuous albuterol the asthma score is reassessed every two hours while receiving continuous albuterol this is the scoring system we use we evaluate respiratory rate pulse oximetry breast sounds presence of retractions and dyspnea a higher score

Indicates more severe symptoms if a child scores in the moderate or severe range they are a candidate for continuous albuterol in the ed a score of 12 or more is an indication to start continuous albuterol and it is an option when the score is 8 to 11. the patient is reassessed and re-scored after one hour of treatment continuous can be stopped when the score

Is 11 or less for inpatients who require continuous it can be discontinued after 4 hours of treatment if the score is 11 or less in our practice we use a large volume nebulizer with a face mask to administer continuous albuterol unless respiratory support such as high flow nasal cannula or non-invasive ventilation is required and then a vibrating mesh nebulizer

Is used we evaluated the use of continuous albuterol with the asthma pathway as part of the quality improvement study inclusion criteria where children two years and older admitted to the picu or step down unit for acute asthma between november 2017 in december 2019 and received continuous albuterol as part of the asthma pathway only the first admission was

Included chart data was collected retrospectively and included demographics asthma classification continuous albuterol dose and duration type nebulizer to deliver continuous the pediatric asthma score before continuous was started while it was being given and after discontinuation respiratory support required while receiving continuous if they were prescribed an

Inhaled steroid prior to admission length of stay and readmissions or eating visits within 30 days of discharge descriptive statistics were used to summarize results 412 children were included the median age was six years most were male black and non-hispanic the majority were emitted from the ed to the step-down unit and most were classified as having moderate

Persistent asthma at the time of emission the meeting of starting dose for continuous albuterol was 15 milligrams per hour and meaning in time on continuous was 560 minutes or a little over nine hours the large volume nebulizer was most commonly used the median asthma score before continuous was started and while receiving it was eleven and after it was stopped

The median score was six sixteen percent of subjects had missing scores before starting continuous and two percent during and after 29 required respiratory support with most of those being high flow nasal cannula three percent required restart-up continuous after it was initially discontinued only two percent required transfer to picu for escalation of care there

Are no pneumothoraxes or deaths reported almost half of all children were prescribed an inhaled steroid prior to the emission the median length of stay was 1.4 days and there were very few eating visits or readmissions within 30 days of discharge studies have shown that asthma management protocols can improve patient outcomes and increase adherence to treatment

Guidelines the pediatric asthma score is a validated tool used to determine treatment for acute asthma and continuous albuterol is safe and well tolerated there were several limitations to our study this was a retrospective chart review there were some instances of missing asthma scores so it isn’t known if the score was within the parameters for indication for

Continuous and we only reviewed the chart to see if inhale steroids were prescribed prior to the emission we did not evaluate if they were adherent to therapy we found the asthma pathway to be safe when using it to initiate and discontinue continuous albuterol there were few escalations of care and eating visits and readmissions within 30 days of discharge did

Not occur often we need to further explore the missing asthma scores and increase our efforts to improve documentation

Transcribed from video
Nikki Danner – Use of Continuous Albuterol in a Pathway for Treatment of Pediatric Acute Asthma By Respiratory Care