A Critical Asthma Standardized Clinical and Management Plan Reduces Duration of Critical Asthma Therapy

Wong, Jackson; Agus, Michael S. D.; Melendez, Elliot

doi:10.1542/hpeds.2016-0087

Cited by 18 publications

(21 citation statements)

References 23 publications

(23 reference statements)

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“…Overall, each PICU cares for a small number of heterogeneous patients with relatively rare diseases, which emphasizes the need for international collaboration. An integral approach to improve care could be realized through a standardized clinical assessment and management plan (SCAMP) and might provide evidence of the effectiveness of these therapies [8].…”

Section: Discussionmentioning

confidence: 99%

“…Most pediatric asthma guidelines offer evidence-based approaches to the management of asthma exacerbations (oxygen, inhaled beta-agonists, and systemic corticosteroids). However, they struggle with an evidence-based approach for SAA beyond these initial steps [8][9][10]. There is a broad arsenal of adjunct therapies in case the child is not responding to conventional treatment, but the evidence is often unclear, conflicting or absent in the context of PICU care in literature.…”

Section: Introductionmentioning

confidence: 99%

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Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey

et al. 2019

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Most pediatric asthma guidelines offer evidence-based or best practice approaches to the management of asthma exacerbations but struggle with evidence-based approaches for severe acute asthma (SAA). We aimed to investigate current practices in children with SAA admitted to European pediatric intensive care units (PICUs), in particular, adjunct therapies, use of an asthma severity score, and availability of a SAA guideline. We designed a cross-sectional electronic survey across European PICUs. Thirty-seven PICUs from 11 European countries responded. In 8 PICUs (22%), a guideline for SAA management was unavailable. Inhaled beta-agonists and anticholinergics, combined with systemic steroids and IV MgSO 4 was central in SAA treatment. Seven PICUs (30%) used a loading dose of a short-acting beta-agonist. Eighteen PICUs (49%) used an asthma severity score, with 8 different scores applied. Seventeen PICUs (46%) observed an increasing trend in SAA admissions. Conclusion: Variations in the treatment of children with SAA mainly existed in the use of adjunct therapies and asthma severity scores. Importantly, in 22% of the PICUs, a SAA guideline was unavailable. Standardizing SAA guidelines across PICUs in Europe may improve quality of care. However, the limited number of PICUs represented and the data compilation method are constraining our findings. What is Known: • Recent reports demonstrate increasing numbers of children with SAA requiring PICU admission in several countries across the world. • Most pediatric guidelines offer evidence-based approaches to the management of asthma exacerbations, but struggle with evidence-based approaches for SAA beyond these initial steps. What is New: • A large arsenal of adjunct therapies and 8 different asthma scores were used. • In a large number of PICUs, a written guideline for SAA management is lacking.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey

et al. 2019

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“…A multidisciplinary group that consisted of pediatric hospitalists, nurses, respiratory therapists, and a pharmacist reviewed and modified the original pathway from Wong et al 19 Changes included the identification of inclusion criteria, definition of transfer criteria, and reduction of the threshold for the administration of heliox. In the pathway, the use of continuous albuterol, intravenous steroids, intravenous magnesium, and heliox as an augmentative therapy was standardized.…”

Section: Interventionmentioning

confidence: 99%

“…16 However, there remains some uncertainty about how and when to initiate these augmentative therapies, and limited data about their efficacy exist. 17,18 In a 2017 study, Wong et al 19 showed a reduction in the length of time on continuous albuterol using a stepwise approach to therapy escalation driven by an asthma severity score. A subsequent iteration of that pathway resulted in a significant decrease in LOS and time to albuterol administered every 4 hours (q4h), which is a proxy of clinical recovery and discharge readiness.…”

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confidence: 99%

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A Clinical Pathway for the Care of Critically Ill Patients With Asthma in the Community Hospital Setting

Smith

Banville

Gruver

et al. 2019

Hospital Pediatrics

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OBJECTIVES: The management of severe pediatric asthma exacerbations is variable. The use of clinical pathways has been shown to decrease time to clinical recovery and length of stay (LOS) for critically ill patients with asthma in freestanding children’s hospitals. We sought to determine if implementing a clinical pathway for pediatric patients who are on continuous albuterol in a community hospital would decrease time to clinical recovery and LOS. METHODS: A clinical pathway for guiding the initiation, escalation, and weaning of critical asthma therapies was adapted to a community hospital without a PICU. There were 2 years of baseline data collection (from September 2014 to August 2016) and 16 months of intervention data collection. Segmented regression analysis of interrupted time series was used to evaluate the pathway’s impact on LOS and time to clinical recovery. RESULTS: There were 129 patients in the study, including 69 in the baseline group and 60 in the intervention group. After pathway implementation, there was an absolute reduction of 10.2 hours (SD 2.0 hours) in time to clinical recovery (P ≤ .001). There was no significant effect on LOS. There was a significant reduction in the transfer rate (27.5% of patients in the baseline period versus 11.7% of patients in the intervention period; P = .025). There was no increase in key adverse events, which included the percentage of patients who required ICU-specific therapies while awaiting transfer (7.3% of patients in the baseline period versus 1.7% of patients in the intervention period; P = .215). CONCLUSIONS: The implementation of a clinical pathway for the management of critically ill children with asthma and on continuous albuterol in a community hospital was associated with a significant reduction in time to clinical recovery without an increase in key adverse events.

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The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

Siraj

Stark

McKinley

et al. 2021

Pediatric Pulmonology

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Objective: To assess face validity, interobserver reliability, and the ability to discriminate escalations of care within 24-h of admission (late rescues) for the bronchiolitis severity score (BSS) for children hospitalized for acute bronchiolitis.Hypotheses: The BSS will yield variable face validity, have clinically relevant interobserver reliability (kappa > 0.7), and distinguish late rescues during hospitalization.Methods: We performed a combined retrospective and prospective, mixed methods study where (1) interobserver agreement was prospectively assessed by overall and subcategory congruence (kappa) calculations, (2) face value were qualitatively assessed from aggregate questionnaire responses, and (3) construct validity for late rescues were assessed using receiver operator characteristic (ROC) curve analyses.Results: Face validity, assessed from 39 questionnaire respondents, were generally positive for BSS utility, reliability, and usability. The BSS exhibited weak interobserver reliability (kappa = 0.22, 95% confidence interval [CI]: 0.11-0.31) calculated from 72 sequential, blinded calculations. Retrospectively, 181 children less than 2 years of age admitted to the general pediatric ward for acute bronchiolitis from November 2017 to April 2019 were identified of which 18 (9.9%) experienced late rescues. Admission BSS values were no different for children with and without late rescues (6[3,6] vs. 4[3,6]; p = .09). An ROC curve analysis revealed an area under the curve of 0.61 (95% CI: 0.48-0.75; threshold ≥6 with sensitivity = 56%, specificity = 69%) for BSS to discriminate late rescues. Conclusion:Although clinicians expressed favorable perceptions of BSS face and content validity, we noted weak interobserver reliability and limited construct validity. Further development and validation are needed to strengthen the BSS before routine use.

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A Critical Asthma Standardized Clinical and Management Plan Reduces Duration of Critical Asthma Therapy

Abstract: A Critical Asthma SCAMP was effective in decreasing time on continuous albuterol.

Cited by 18 publications

References 23 publications

Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey

Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey

A Clinical Pathway for the Care of Critically Ill Patients With Asthma in the Community Hospital Setting

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

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