Background: Patients with
status asthmaticus admitted to the hospital contribute tremendous costs to the healthcare system. Treatment protocols directed at improving care to pediatric inpatients have improved both clinical and financial outcomes; however, there are limited data demonstrating the impact of goal-driven
therapy for patients with
status asthmaticus in the pediatric intensive care unit (PICU). The purpose of this initiative was to standardize care of children with
status asthmaticus in the PICU to improve clinical outcomes. Materials and Methods: A goal-directed clinical pathway using a validated pediatric
asthma severity score was developed. A pre-post intervention assessed patients 2-17 years of age admitted to the PICU with
status asthmaticus. The effect of the protocol was measured from October 2015 to October 2016. The primary outcome was the transition time interval from continuous nebulized
bronchodilator therapy to every 2 hourly intermittent treatments. Secondary outcomes related to treatment options and clinical complications were also assessed. Results: Postintervention patient (n = 124) demographics were similar to those in the preintervention group (n = 130). Compared with baseline, there was a 4.9-h decrease in the mean transition time from continuous to intermittent
bronchodilator use (31.9 versus 27.0, P = 0.033) following the intervention. The mean and median hospital
length of stay (LOS) was significantly decreased in the postintervention group by 14.76 h (P = 0.011) and 16.68 h (P = 0.003). There were no readmissions to the PICU in the postintervention group. The use of rescue BiPAP (Bi-level positive airway pressure ventilation) was significantly higher in the preintervention group compared with the postintervention group (42% versus 28%, P = 0.036). Conclusions: A severity-tiered, goal-driven treatment pathway for pediatric patients admitted to the PICU with
status asthmaticus reduced the time required to transition from continuous to intermittent inhaled
bronchodilator use. As a result, overall hospital LOS was significantly decreased with no increase in clinical complications.