• Elliot Melendez, Danielle Dwyer, Daria Donelly, Denise Currier, Daniel Nachreiner, D Marlowe Miller, Julie Hurlbut, Michael J Pepin, AgusMichael S DMSDDivision of Medicine Critical Care, Boston Children's Hospital, Harvard Medical School Boston, MA., and Jackson Wong.
• Division of Medicine Critical Care, Boston Children's Hospital, Harvard Medical School Boston, MA.
• Pediatr Crit Care Me. 2020 May 1; 21 (5): 451-460.

ObjectivesThe primary aim of this study was to reduce duration of continuous albuterol and hospital length of stay in critically ill children with severe status asthmaticus.DesignObservational prospective study from September 2012 to May 2016.SettingMedicine ICU and intermediate care unit.PatientsChildren greater than 2 years old with admission diagnosis of status asthmaticus admitted on continuous albuterol and managed via a standardized protocol.InterventionsThe protocol was an iterative algorithm for escalation and weaning of therapy. The algorithm underwent three revisions. Iteration 1 concentrated on reducing duration on continuous albuterol; iteration 2 concentrated on reducing hospital length of stay; and iteration 3 concentrated on reducing helium-oxygen delivered continuous albuterol. Balancing measures included adverse events and readmissions.Measurements And ResultsThree-hundred eighty-five patients were treated as follows: 123, 138, and 124 in iterations 1, 2, and 3, respectively. Baseline data was gathered from an additional 150 patients prior to protocol implementation. There was no difference in median age (6 vs 8 vs 7 vs 7 yr; p = 0.130), asthma severity score (9 vs 9 vs 9 vs 9; p = 0.073), or female gender (42% vs 41% vs 43% vs 48%; p = 0.757). Using statistical process control charts, the mean duration on continuous albuterol decreased from 24.9 to 17.5 hours and the mean hospital length of stay decreased from 76 to 49 hours. There was no difference in adverse events (0% vs 1% vs 4% vs 0%; p = 0.054) nor in readmissions (0% vs 0% vs 1% vs 2%; p = 0.254).ConclusionsImplementation of a quality improvement protocol in critically ill patients with status asthmaticus was associated with a decrease in continuous albuterol duration and hospital length of stay.

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