Trial of A Therapist-Directed Protocol for Weaning Bronchodilator Therapy in Children with Status Asthmaticus

Abstract

Background

The Children's Hospital Medical Center in Cincinnati, Ohio implemented a respiratory therapist-directed protocol for weaning β-agonist aerosols in pediatric status asthmaticus. We studied whether the protocol conferred advantages over the existing practice, wherein changes to the frequency of aerosol administration were directed by the physician.

Methods

Clinical outcomes were compared between 71 controls (C) and 70 protocol patients (P).

Results

In the P group, fewer aerosols were administered, and the time required to wean aerosol frequency to every 6 hours was shorter. However, the lag time between reaching the 6-hour aerosol frequency and the discharge order was longer in the protocol group. There was no significant difference in length of stay, cases where aerosol frequency was re-increased, returns to the emergency department, or hospital readmission within 1 week. Respiratory therapist compliance to the protocol improved during the study period, but review of the therapist records suggests that approximately one third of the aerosol treatments administered during the protocol could have been withheld, given the specified objective criteria of respiratory distress.

Conclusion

With carefully de-signed assessment criteria and protocol training, a respiratory therapist-directed protocol for weaning β-agonist aerosols can improve pediatric asthma patient care in a teaching hospital.