Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use

Objectives: Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus. Design: Time series quality improvement trial. Setting: PICU in a tertiary care children’s hospital. Patients: Children age 2–18 years old with a known diagnosis of asthma presenting with status asthmaticus. Intervention: One-hundred five admissions to a PICU for status asthmaticus were treated according to a new de-escalation pathway between August 15, 2015, and August 30, 2016. This group was compared with a prepathway group of 141. Measurements and Main Results: Primary outcome was variability in PICU length of stay. Secondary outcomes were median PICU length of stay, median hospital length of stay, and median duration a patient received continuous nebulized albuterol. The effectiveness of the intervention was tracked using control charts. The postpathway group demonstrated decreased variability of PICU length of stay and time receiving continuous albuterol. Statistically significant decreases were seen in median PICU length of stay (16 vs 13 hr; p = 0.0009), median duration a child spent receiving continuous nebulized albuterol (10.8 vs 7.3 hr; p = 0.0008), and median hospital length of stay (37 vs 31 hr; p = 0.02). Total number of asthma assessments completed by respiratory therapists increased from 741 to 1,087. Conclusions: Implementation of a PICU asthma de-escalation pathway demonstrated statistical decrease in the reported measures for children with status asthmaticus. Although the clinical significance of these changes may be debatable, the results demonstrate that efforts to standardize asthma care in the PICU setting is an area in need of further study. Dr. Brennan was involved in the conception, design, and implementation of this project. He drafted the initial article, performed a portion of the statistical analysis, and created the control charts. Dr. Lowrie was involved in the conception, design, and implementation of this project. She reviewed the analysis and approved the final article for submission. Dr. Wooldridge was involved in the conception, design, and implementation of this project. She reviewed the analysis and approved the final article for submission. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: skbrennan@wustl.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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