Severe refractory status asthmaticus, research, and current trends

Transcript:

Lauren Flagg, DNP, APRN, CPNP-AC:

Hi, I'm Lauren Flagg. I'm a nurse practitioner at Yale New Haven Hospital in the Pediatric Intensive Care Unit. I'm also faculty in the Acute Care Pediatric Nurse Practitioner program at Yale University School of Nursing. Firstly, I love coming to NAPNAP to support nurse practitioners, pediatric nurse practitioners in general. I love bringing my students; I think it's a wonderful experience for them and [offers] to network with people I know from across the country.

In terms of asthma, there's such a strong support of asthma, [it] has its own special interest group here at NAPNAP and while there's a lot of information about the primary care aspect of this and pre-hospital setting, talking about evidence-based practice, as we move forward and severity, I thought was an important topic.

We went over a case-based review loosely based on a patient case, they actually took care of in the ICU, and went through the current modalities that are recommended for severe refractory status asthmaticus and what you find is as you move forward and severity, there's far less research and we're talking about really small values of patients. There's currently no consensus on where our strategies should go in terms of what our priority medications, when we're escalating. In terms of asthma scoring tools, which are significantly used in the emergency room and in the inpatient setting, there's no consensus on which one of those is the most appropriate.

In fact, there's not a huge amount of validity and interrater reliability in the asthma scoring tools or comparison, in terms of which is the most reliable, and also I brought up in terms of interdisciplinary reliability. So whether physicians vs respiratory therapists vs nurses, how we would rate those same patients using different scoring tools in which is the most reliable.

In terms of the scoring tools, I would say the advice was, please go forth and help contribute to the research. I think it's important that as a community, we look into validity and reliability, interrater reliability on some of these tools, and working towards answering some of those questions. In terms of contributing to the research as we move on and severity, I think without some of that ability to provide objective measurement between multiple institutions, you're talking about, sometimes very small n value. So in order to actually have that large body of research, we need to be able to compare in database type of situation.

I work in an area that does have pretty significant asthma in New England, and I work in an underserved low socioeconomic area, so we do have a lot of issues with pretty significant asthma and this year, particularly was quite heavy. The patient that I was talking about was actually not from this year, so there's different years I feel like in the respiratory virus season, I've had some really severe status asthmaticus patients and I think other people see those trends as well.

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