• Steven Brennan, Lia Lowrie, and Jamie Wooldridge.
• Department of Pediatrics, St. Louis University, St. Louis, MO.
• Pediatr Crit Care Me. 2018 Jul 1; 19 (7): 658-664.

ObjectivesEvaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus.DesignTime series quality improvement trial.SettingPICU in a tertiary care children's hospital.PatientsChildren age 2-18 years old with a known diagnosis of asthma presenting with status asthmaticus.InterventionOne-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 ResultsPrimary 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.ConclusionsImplementation 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.

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