2010 OPEN FORUM Abstracts
UTILIZING AN ALGORITHM TO GUIDE RESPIRATORY CARE FOR THE PEDIATRIC PATIENT WITH ACUTE CHEST SYNDROME.
Suzanne Iniguez, Lee Evey; Respiratory Care, Texas Childrens Hospital, Houston, TX
BACKGROUND: About 50% of patients diagnosed with acute chest syndome (ACS) will develop a respiratory complication during hospitalization for another problem, i.e. pain crisis. ACS is estimated to account for 25% of Sickle Cell Disease (SCD) related deaths. A multi-disciplinary team was created to develop a treatment plan for this patient population and to develop an evidencebased practice guideline, part of this guideline focused on the respiratory care that these patients should receive. METHOD: The patient population to be included was from age 1 to 21 years with an acute illness associated with lower respiratory symptoms, new hypoxemia, or new infiltrate on chest x-ray. The patients were scored using the Clinical Respiratory Score (CRS) which is a tool the Respiratory Care Department utilizes as part of the patient assessment. The patients CRS number determined the care they would receive based on a treatment algorithm, ranging from supplemental oxygen and incentive spirometry Q2 to High Frequency Chest Wall Oscillation (HFCWO), IntraPulmonary Percussive Ventilation (IPV) and BiPAP therapy. Nursing on the in patient floors also received education on the CRS and assisted with the Q2 therapy so the work load could be easily managed. Oxygen saturations are maintained at greater than or equal to 94%. The patients are assessed Q4 and a CRS is assigned, this then determines the intensity of the respiratory therapy. RESULTS: The department has seen a significant increase in the therapy offered to this patient population in some instances increasing the workload by one FTE. The length of stay (LOS) has decreased with the average LOS being 4.3 decreased 0.46 from the initial pilot data. CONCLUSIONS:The department is still investigating the best therapies to offer this patient population for increased compliance and best results. Sponsored Research - None