The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

DOES NEBULIZER BRAND MAKE A CLINICAL DIFFERENCE IN THE EMERGENCY ROOM MANAGEMENT OF PEDIATRIC ASTHMA?

Timothy R Myers RRT, Robert Chatburn RRT, Marsha Rogers CRTT, Karen Camasso-Richardson MD, Carolyn Kercsmar MD. University Hospitals of Cleveland and Case Western Reserve University. Cleveland, OH.

BACKGROUND: All children visiting our emergency department (ED) for asthma are treated using an asthma care path (ACP). The ACP is an assessment-driven, algorithm-based treatment regimen. AIM: To determine if nebulizer brand utilized in the ED treatment of children with status asthmaticus makes a difference in patient and/or clinical outcomes.

Methods: We randomized 280 children, ages of 1 through 7, to receive standardized treatment (3.75 mg of Albuterol) in our ACP with three different nebulizers (Marquest's Acorn, Westmed's Circulaire, and Salter's Nebutech). The ACP standardized assessments and therapy (02, albuterol aerosols and corticosteroids) at prescribed intervals (every twenty minutes). Treatment was discontinued when discharge criteria were met: good air exchange, mild or absent end expiratory wheezing, no accessory muscle usage, Sp02 > 93% and respiratory rate < 40/min. After meeting criteria, patients were observed for an hour and discharged home. Patients not meeting discharge criteria after six aerosols or one hour of continuous aerosols were admitted. A chronic asthma severity was assigned based on history, symptoms, and therapeutic drug usage.

Results: Retrospectively, twenty-one children originally randomized to the study were eliminated from the results for the following reasons: inappropriate age (6), inappropriate diagnosis (7), removed from study by guardian (1), and not receiving at least 1 ED treatment (7) by assessment. Outcomes were analyzed by ANOVA and Chi Square tests (p < 0.05) for the 259 children completing the study. A comparison of the predetermined outcomes by means (SD) or percentages are listed in the tables below.

Demographics Acorn Circulaire Nebutech p value
Number 88 86 85
Age 3.6 ± 1.9 4.2 ± 2.0 4.1 ± 2.3 0.10
Gender (male) 78% 64% 69% 0.09
Non-caucasian 84% 85% 85% 0.97
SpO2 at presentation (%) 94.7 ± 3.4 94.7 ± 3.4 95.5 ± 3.1 0.14
Respirations @ presentation 44.2 ± 12.8 41.2 ± 12.9 41.2 ± 15.6 0.28
Severe Asthma 34% 36% 34% 0.94
Outcomes
ED length of stay (hrs) 2.4 ± 0.8 2.5 ± 0.8 2.1 ± 0.8 0.001
Treatment duration (hrs) 2.2 ± 0.8 2.2 ± 0.7 1.8 ± 0.6 0.001
Aerosols given 4.3 ± 1.6 4.1 ± 1.7 3.1 ± 2.0 <0.001
Hospital admits 47% 36% 23% 0.02
ICU admits 3% 6% 4% 0.57

CONCLUSION: In this study, patients treated with the Nebutech nebulizer demonstrated significant decreases in ED length of stay, total treatment times, admission rates and mean number of treatments given compared to the other two devices (Acorn and Circulaire). In our ED study, nebulizer brand utilized to treat pediatric asthma appears to make an impact on both clinical and financial outcomes.

OF-99-045

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