The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

NASOPHARYNGEAL (NP) SUCTIONING AND ALBUTEROL IN BRONCHIOLITICS

Kim Bennion BS, RRT,. John W. Salyer MBA, RRT, QCAT Team Members. Respiratory Care Service, Primary Children's Medical Center. School of Medicine, University of Utah

Introduction: Our hospital has a multi-disciplinary assessment/care team that specializes in the care of bronchiolitics. The team is called the Quality Care Assessment Team (QCAT) and has 8 specially trained RCP's. They daily assess all bronchiolitics receiving any respiratory interventions. The team employs a standardized protocol for aerosolized albuterol, NP suctioning with a catheter, and a symptom based respiratory scoring system. The protocol includes an albuterol trial that can be described in the following order; baseline score, suction, repeat score, albuterol treatment (tx), and repeat score. The score is based on respiratory rate, breath sounds, and retractions, each being scored on 4 levels (0-4). Scores are classified as; 0-1 normal, 2-3 mild distress, 4-6, moderate distress, 7-9 severe distress. We sought to determine if intervention with NP suctioning reduced the need for further intervention with albuterol. Methods: Respiratory scores were retrospectively determined from assessment cards filled out by QCAT members during routine care. Data were included from patients with; (1) discharge diagnoses of bronchiolitis, (2) an ordered trial of aerosolized albuterol, (3) all necessary data fields completed. Cards were pulled predominantly from cases in the last two bronchiolitis seasons. An improvement was defined as a decrease in the respiratory score before and after intervention (either suctioning or aerosol tx) of ³ 1. Patients were classified according to whether or not their respiratory scores improved, worsened or were unchanged after interventions. Proportions were tested for statistical significance using Chi square analyses with significance established as P£ 0.05. Results: There were 166 cards that met the criteria. The data in the following table have a Chi Square of 14.5 and a P = 0.006.

Improved after Tx No change after Tx Worsened after Tx
Improved after Sx 9 (5.4) 70 (42.2) 9 (5.4)
No Change after Sx 13 (7.8) 54 (32.5) 5 (3.0)
Worsened after Sx 4 (2.4) 2 (1.2) 0 (0)
Data are numbers and (%) of patients.

Discussion: Debate continues regarding efficacy of respiratory interventions in bronchiolitis care. Our clinicians have long held that the appropriate use of suctioning all the way into the pharynx through both nares using a catheter, often resulted in substantial improvements that obviated the need for further tx with albuterol. All our suctioning is performed this way in bronchiolitics. Our findings seem to support this premise. Ours is a convenience sample (strictly speaking). However, we felt that the factors that caused cards to be incomplete were probably largely random and thus our sample probably is reflective of bronchiolitics as a whole.

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