Continuous Albuterol in Pediatric Acute Care: Study Demonstrates Safety Outside the Intensive Care Unit

Amanda F Messer; Esther M Sampayo; Brent Mothner; Elizabeth A Camp; Jennifer Jones; Terri Brown; Joyee Vachani

doi:10.1097/pq9.0000000000000225

Continuous Albuterol in Pediatric Acute Care: Study Demonstrates Safety Outside the Intensive Care Unit

Pediatr Qual Saf. 2019 Dec 5;4(6):e225. doi: 10.1097/pq9.0000000000000225. eCollection 2019 Nov-Dec.

Authors

Amanda F Messer¹, Esther M Sampayo², Brent Mothner³, Elizabeth A Camp², Jennifer Jones², Terri Brown⁴, Joyee Vachani³

Affiliations

¹ Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, La.
² Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
³ Division of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex.
⁴ Quality and Outcomes Management, Texas Children's Hospital, Houston, Tex.

Abstract

There are little data to support the use of continuous aerosolized albuterol (CAA) in the non-intensive care unit (ICU) or non-emergency department (ED) setting for pediatric asthma patients. A 2014 study demonstrated low rates of adverse outcomes associated with administration of CAA on the acute care unit; however, the authors do not describe additional outcomes. We sought to determine whether administration of CAA within a respiratory cohort on an acute care floor was feasible and safe.

Methods: This quasi-experimental study evaluates data 1 year before and after (2014-2016) the initiation of CAA on the acute care inpatient unit for asthma patients 2-18 years of age. Outcome measures included ED and hospital length of stay (LOS), readmission rate, rapid response team activations, and transfers to ICU. Use of chest x-rays, viral studies, and hospital charges were also studied.

Results: Seven hundred thirty-two patients met study criteria. Population demographics and severity of acute presentation were similar pre- and poststudy. ED LOS decreased poststudy, whereas overall hospital LOS was unchanged. Fifteen-day readmission rate decreased in the poststudy group. Only 4 rapid response activations occurred in the poststudy population. The poststudy group utilized fewer chest x-rays and viral studies. There was no change in overall hospital charges.

Conclusions: With appropriate resources and safety processes in place, care of pediatric patients with status asthmaticus receiving CAA on an acute care unit, outside of the ICU, resulted in improved ED LOS with evidence of lower resource utilization and rare adverse outcomes.