The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

EVIDENCE BASED INFANT TODDLER RESPIRATORY PROTOCOLS

Thomas A. Seidensticker; Respiratory Care, Rush Copley Medical Center, Carol Stream, IL

Introduction: Infants and Toddlers admitted to the hospital for treatment of RSV/bronchiolitis are often placed on bronchodilator therapy as a mainstay treatment modality. A review of the literature found no evidence for the routine use of bronchodilators for this disease entity in this age group. Numerous studies have shown that outcomes for length of stay and number of days requiring supplemental oxygen were no different between infants treated with nebulized albuterol, racemic epinephrine or placebo (normal saline). Therefore, to better manage the use of bronchodilators as treatment modality in the RSV/bronchiolitis patient group,a bronchiolitis respiratory protocol utilizing a point system was implemented to classify infants into categories based on severity of symptoms:intensity of wheezing,depth of retractions,nasal flaring, tracheal tugging, and the amount of oxygen needed to maintain O2 sats above 92%. The patients with point totaling 0-2 received albuterol treatments only on an as-needed (prn) basis for documented wheezing. Since infants are obligate nose breathers,the copious nasal secretions which is the hallmark of RSV/bronchiolitis interfers with oxygenation and ventilation in this age group. Emphasis was shifted from bronchodilator therapy to clearing of nasal secretions by suctioning with acorn nasal aspirators or bulb syringes. Chest physical therapy was employed only for documented lung consolidation via chest xray, and automatically discontinued upon resolution of the condition. Results: A retrospective study of 37 patients admitted to the pediatric unit at Rush Copley Medical Center prior to the use of the respiratory bronchiolitis protocols were compared to 39 patients whose respiratory modalities were managed with the bronchiolitis clinical pathway. The ages of the two groups were statistically the same (7.2 months vs 7.7 months, p >0.05). There was no difference in length of stay (2.2 days vs 2.6 days, p > 0.05). However, there was a significant reduction in the average number of nebulizer treatments per admission, from 12.1 to 8.5 treatments. This reduction in the number of treatments per admission translated into a significant cost savings over the RSV season. The protocols were later expanded to all infants and toddlers who were admitted to the pediatric unit and placed on respiratory care modalities. Sponsored Research - None

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