Reduced hospital length of stay (LOS) and reduced duration of continuous albuterol medication are just 2 of the benefits of standardized acute asthma management using score-based, respiratory therapist (RT)-driven pathways and procedures. Outside of the pediatric intensive care unit (PICU), evidence on the safety of continuous albuterol administration is scant. At the facility, the asthma route is based on a modified version of the pediatric asthma score (PAS). The feasibility and efficacy of employing PAS to initiate/stop continuous albuterol were assessed as part of a score-based, RT-driven asthma pathway. 

Children older than or equal to 2 years old who were given continuous albuterol as part of the asthma pathway throughout 2017-2019 were studied. They had been brought to the PICU or step-down unit due to an asthma exacerbation. PAS, dose, and duration of continuous albuterol, LOS, and complications were retrieved from the data set together with other demographic and clinical information. Patients hospitalized in the pediatric intensive care unit and the step-down unit were evaluated, and their outcomes were contrasted. 

Medians are used to describe the results (interquartile range). Children ages 6.4 (4.0-10.0) years and weighing 24.8 (17.3-39.5) kg were included in the study (61% were male, 59.9% were Black, 92.7% were non-Hispanic, and 44.9% had moderate chronic asthma). About 71.1% of kids admitted were sent to the step-down facility (15 (10-20) mg/h of albuterol initially, for 9.1 (5.7-16.0) hours, for 1.4 (0.9-2.3) days). About 1/3rd of the people studied needed assistance breathing. Restarting treatment was necessary for 2.9%, admission to the PICU occurred in 1.7% of cases, and intubation occurred in 0.5%. There were no fatalities or cases of pneumothorax. The percentage of patients who returned to the hospital for the same reason as their initial hospitalization was similarly low, at 3.9%. Compared to patients admitted to the step-down unit, those admitted to the PICU were sicker and required more therapies and respiratory assistance. 

Initiating and stopping continuous albuterol for the treatment of pediatric asthma exacerbation using an RT-driven, score-based route was safe and efficacious in the pediatric intensive care unit (PICU) and step-down unit.

Source: rc.rcjournal.com/content/67/11/1396