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THE INTERACTION OF NASOPHARYNGEAL (NP) SUCTION AND ALBUTEROL IN THE TREATMENT
OF BRONCHIOLITIS: A TWO YEAR COMPARISON
Kim Bennion BS RRT, Julie
Ballard BS RRT, QCAT Team Members and John Salyer MBA RRT, Respiratory Care
Services, Primary Children?s Medical Center, School of Medicine, University
of Utah.
Introduction: Our hospital
has a multi-disciplinary assessment team that specializes in the care of the
bronchiolitis. The team is called the Quality Care Assessment Team (QCAT) and
has 7 specially trained RCP?s. They daily assess all bronchiolitics who are
ordered on 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 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 minutes
post 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 are
classified as 0-1 normal, 2-3 mild distress, 4-6 moderate distress, and 7-9
severe distress. We sought to determine if intervention with NP suctioning reduced
the need for further intervention with albuterol in a repeat of a study we conducted
last year (Respir Care 2000;45:1009).
Methods: Data on interventions
and scores were extracted from our data systems. Inclusion criteria were: (1)
diagnoses of brocnhiolitis and <24 months of age (2) an ordered trial
of aerosolized albuterol and (3) a complete set of scores defined as scores
as baseline, post suctioning and post tx. An improvement was defined as a decrease
in the respiratory score >1 from baseline to post intervention (suctioning
or aerosol tx.). Patients were classified according to whether or not their
respiratory scores improved, remained unchanged or worsened after each intervention.
Results: There were 166 patients
in the 99-00 season and 167 in the 00-01 season who met the criteria. Proportions
were tested for statistical significance using Chi Square analyses with significance
established as P < 0.006.
|
Improved
Post
Tx |
No
Change
Post Tx |
Worse
Post
Tx |
| |
99-00
Season |
00-01Season |
99-00
Season |
00-01
Season |
99-00
Season |
00-01
Season |
| Improved
Post Sx |
9 (5) |
10 (6) |
70 (42) |
58 (35) |
9 (5) |
18 (11) |
| No Change
Post Sx |
13 (8) |
20 (12) |
54 (32) |
43 (26) |
5 (3) |
7 (4) |
| Worse
Post Sx |
4 (2) |
6 (3) |
2 (1) |
d>0 (0) |
1 (1) |
Data
are reported in numbers and (%) of patients. |
Discussion: The debate continues
regarding the efficacy of respiratory interventions in bronchiolitis care. With
the use of the scoring system, we try to objectively determine which if any
intervention(s) result in pt improvement. Data from both seasons appear to support
suctioning the nares using a catheter obviates the need for further tx with
albuterol. We feel that the reproducibility of our results gives our finding
considerable validity.
OF-01-243
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