2001 OPEN FORUM Abstracts
THE INTERACTION OF NASOPHARYNGEAL (NP) SUCTION AND ALBUTEROL IN THE TREATMENT OF BRONCHIOLITIS: A TWO YEAR COMPARISON
Kim Bennion BS RRT, JulieBallard BS RRT, QCAT Team Members and John Salyer MBA RRT, Respiratory CareServices, Primary Children?s Medical Center, School of Medicine, Universityof Utah.
Introduction: Our hospitalhas a multi-disciplinary assessment team that specializes in the care of thebronchiolitis. The team is called the Quality Care Assessment Team (QCAT) andhas 7 specially trained RCP?s. They daily assess all bronchiolitics who areordered on respiratory interventions. The team employs a standardized protocolfor aerosolized albuterol, NP suctioning with a catheter and a symptom basedrespiratory scoring system. The protocol includes an albuterol trial that canbe defined as: baseline score, NP suction, repeat score 10-15 minutes post suctioning,an albuterol treatment (tx) if deemed necessary and a repeat score 10-15 minutespost treatment completion. The score is based on respiratory rate, breath sounds,and retractions with each of these being scored on 4 levels (0-3). Scores areclassified as 0-1 normal, 2-3 mild distress, 4-6 moderate distress, and 7-9severe distress. We sought to determine if intervention with NP suctioning reducedthe need for further intervention with albuterol in a repeat of a study we conductedlast year (Respir Care 2000;45:1009).
Methods: Data on interventionsand scores were extracted from our data systems. Inclusion criteria were: (1)diagnoses of brocnhiolitis and <24 months of age (2) an ordered trialof aerosolized albuterol and (3) a complete set of scores defined as scoresas baseline, post suctioning and post tx. An improvement was defined as a decreasein the respiratory score >1 from baseline to post intervention (suctioningor aerosol tx.). Patients were classified according to whether or not theirrespiratory scores improved, remained unchanged or worsened after each intervention.
Results: There were 166 patientsin the 99-00 season and 167 in the 00-01 season who met the criteria. Proportionswere tested for statistical significance using Chi Square analyses with significanceestablished as P < 0.006.
|ImprovedPost Sx||9 (5)||10 (6)||70 (42)||58 (35)||9 (5)||18 (11)|
|No ChangePost Sx||13 (8)||20 (12)||54 (32)||43 (26)||5 (3)||7 (4)|
|WorsePost Sx||4 (2)||6 (3)||2 (1)||d>0 (0)||1 (1)|
Dataare reported in numbers and (%) of patients.
Discussion: The debate continuesregarding the efficacy of respiratory interventions in bronchiolitis care. Withthe use of the scoring system, we try to objectively determine which if anyintervention(s) result in pt improvement. Data from both seasons appear to supportsuctioning the nares using a catheter obviates the need for further tx withalbuterol. We feel that the reproducibility of our results gives our findingconsiderable validity.