A RESPIRATORY THERAPIST-DRIVEN ASTHMA PATHWAY REDUCED HOSPITAL LENGTH OF STAY IN THE PEDIATRIC INTENSIVE CARE UNIT

Miller AG, Haynes KW, Gates RM, Zimmerman KO, Heath TS, Bartlett KW, McLean HS, Rehder KJ. Respir Care. 2019;64(11):1325-1332

Asthma is a common pediatric disease that can require emergency room visits and hospitalization. Status asthmaticus is responsible for more than 500 000 cases in pediatric intensive care units (PICUs). Current data support the use of asthma pathways or protocols to reduce the length of stay of hospitalization or decrease hospitalizations. The authors found there are limited data on the use of asthma pathways in the PICU and how those pathways affected patients. They hypothesized that the implementation of a pediatric asthma pathway would reduce the length of stay in the PICU for patients admitted with asthma.

The researchers retrospectively reviewed charts of patients aged 2 to 17 years admitted to the PICU before (n = 49) and after (n = 154) the asthma pathway was instituted in their facilities' PICU. The primary outcome was the hospital length of stay, and the secondary outcome was PICU length of stay and time on continuous albuterol. The researchers found no significant difference with patient age, gender, home medications, medical history, or route of admission. They found significant decreases in hospital length of stay (4.4 vs 2.7 days), median PICU stays (2.1 vs 1.6 day), and median time on continuous albuterol (39 vs 27 hours). It was also found that patients in the postpathway group were placed on high-flow nasal cannula (32% vs 6%) or noninvasive ventilation (10% vs 4%).

The researchers concluded that implementation of an asthma pathway was associated with decreased hospital length of stay, PICU length of stay, and time on continuous albuterol. They also concluded there was an increase in the use of high-flow oxygen and noninvasive ventilation after implementation of the asthma pathway. The authors also concluded there are no standardized PICU discharge criteria for patients with asthma.