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대한소아알레르기호흡기학회 Allergy Asthma & Respiratory Diseases Allergy Asthma & Respiratory Diseases 제3권 제1호
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2015.1
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30 - 34 (5page)

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Purpose: Early recognition and management of asthma attack is critical before it becomes worse. We developed critical pathway (CP) of asthma attack at Emergency Center (EC) for making undelayed decision and management of asthma attack. Methods: Acute asthma attack assessment and treatment (4AT) CP began on April 1st 2012 and recruited the patients for 18 months. This study enrolled the patients who were older than 15 years and visited EC for dyspnea and wheezing. Initial assessment was done measuring peak expiratory flow rate (PEFR), oxygen saturation (SaO2). Once CP is activated, oxygen, inhalation of short acting β2 agonist, and injection of corticosteroid were administered to the patients. Every hour after CP activated, we reassess the patients’ response and make decisions whether to admit or discharge. Results: Until January 10th 2014, 62 patients enrolled in this study. Seven patients hospitalized for asthma and 40 patients discharged. The other 15 patients were deactivated as they were diagnosed of heart failure, myocardial infarction, aortic dissection, anaphylaxis, chronic obstructive pulmonary disease and pneumonia for the causes of dyspnea. Mean Interval from EC arrival to 4AT activation was 32.6±29.1 minutes and the mean interval from 4AT activation to position decision was 254.5±302.0 minutes. Among 47 patients who were diagnosed with asthma attack, 13 patients were not aware of asthma before this attack. Forty patients were discharged at EC after management of CP. Among them, 34 patients revisited clinic, but 6 patients did not. We called back to the lost 6 patients but only 3 patients were connected. Even they visited EC due to asthma attack, 2 patients had no insight of importance of regular management and the other one promised to revisit. Conclusion: CP was successful for early management of asthma attack. However, 15% of discharged patients never show up again. So, education program about the importance of ongoing management of asthma for prevention of asthma attack is needed.
#Asthma #Critical pathways #Emergency treatment

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참고문헌 (24)

참고문헌 신청
Bailey R / 1998 / Impact of clinical pathways and practice guidelines on the management of acute exacerbations of bronchial asthma / Chest 113 : 28 ~ 33 google schola Berenholtz S / 2001 / Assessing the effectiveness of critical pathways on reducing resource utilization in the surgical intensive care unit / Intensive Care Med 27 : 1029 ~ 1 google schola Burgers PT / 2014 / Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients / In google schola Dy SM / 2005 / Critical pathway effectiveness: assessing the impact of patient, hospital care, and pathway characteristics using qualitative comparative analysis / Health Ser google schola Gadacz TR / 1997 / General surgical clinical pathways : an introduction / Am Surg 63 : 107 ~ 110 google schola

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