Location:  North Shore-LIJ

Hypothesis:  Early administration of IV terb, prior to PICU admission, for severe asthma patients will prevent need for both noninvasive ventilation and intubation

Method:  Retrospective chart review

Studied 35 patients from outlying EDs who had short pre-PICU duration of terbutaline drip (i.e., later in the course of ED treatment, including 25 whose pre-PICU terb time was 0 because they didn’t get it until arrival) and 85 patients from the LIJ ED who mostly had longer pre-PICU durations of terbutaline (i.e., earlier in the course of ED treatment.  There were 120 patients total.

Both groups had similar vital signs prior to terbutaline infusion (see below)

Both groups received at least 3 doses albuterol nebs, IV steroids and magnesium IV x 1

Results:

-Patients from outlying EDs had short pre-PICU duration of IV terb (0.69 hours +/- 1.38) when compared to LIJ ED (2.91 hours +/- 2.47)

-Mean periods of pre-PICU terbutaline infusion were 2.61 hours for patients who did not require any ventilation, 2.04 hours for patients requiring noninvasive ventilation and 0.97 hours for patients requiring intubation (p=0.015)

Limitations:

 -Only used RR and HR to determine severity of patients–did not use ABG data, end tidal, pulse ox (!), asthma score or lactate.  Although the initial vitals were comparable between groups, I still wonder if some patients who were not as sick using these additional parameters were not transferred from outside hospitals whereas they saw all moderately severe to severe patients from the LIJ ED.

Despite this, there’s some suggestion that we might need to think about IV terb a bit earlier in the course of our treatment of severe asthma.