RT Journal Article SR Electronic T1 Use of Continuous Albuterol in a Pathway for Treatment of Pediatric Acute Asthma JF Respiratory Care FD American Association for Respiratory Care SP 3605549 VO 66 IS Suppl 10 A1 Danner, Nikki A1 Lloyd, Tera A1 Carper, Naisha A1 Willis, Denise A1 Berlinski, Ariel YR 2021 UL http://rc.rcjournal.com/content/66/Suppl_10/3605549.abstract AB Background: Use of RT-driven protocols allows for standardization and improves quality of care. At our institution, inpatient treatment of acute asthma exacerbation in children ≥ 2 y old is managed with a score-based pathway that uses a modified Pediatric Asthma Score (PAS) [Qureshi et al. Effect of nebulized ipratropium on the hospitalization rates of children with asthma. N Engl J Med 1998;339(15):1030-1035]. The pathway is RT-driven and provides score-based guidance for initiation (PAS ≥ 8) and discontinuation (PAS ≤ 11) of continuous albuterol (CA). We use a vibrating mesh nebulizer (VMN) to deliver CA when patients are receiving respiratory support (HFNC, NIV), and a large volume nebulizer (LVN) otherwise. We evaluated the use of CA during asthma exacerbation treatment with the asthma pathway as part of a quality improvement process. Methods: First hospitalization of children ≥ 2 y old admitted to PICU or step down unit for acute asthma exacerbation between 11/2017–12/2019 who were prescribed CA as part of the asthma pathway were included in a retrospective chart review. Data collected included: age, sex, asthma severity, CA dose/duration, nebulizer type, PAS (before, during, after CA), and length of stay. Need to restart CA, transfer to PICU, and death were recorded. Results: We identified 412 subjects with median age of 6 years (IQR 4–10). The majority were male (61%) and admitted from the emergency department to the step down unit (71%). Asthma severity was classified as mild, moderate, severe, and unspecified in 10%, 45%, 24%, and 20% of subjects respectively. Median initial dose and time on CA were 15 mg/h (IQR 10–20) and 9 h 20 min (IQR 5 h 55 min–16 h 38 min). PAS before, during, and after CA was 11 (IQR 10–12), 11 (IQR 9–12) and 6 (IQR 5–8) respectively. One type of device was used in 85% (LVN 71%, VMN 14%). PAS documentation was missing in 16%, 2%, and 2% before, during, and after CA respectively. 28% received respiratory support (HFNC or NIV). Median length of stay was 1.4 d (IQR 0.8–2.3). CA was restarted in 3% of subjects, and 2% required transfer to PICU due to escalation of care. No deaths were reported. Conclusions: The use of a score-based pathway for initiation/discontinuation of CA for treatment of pediatric asthma exacerbation was safe with low complication rates at our institution. Efforts towards increasing documentation before starting CA are warranted.