Koorevaar, I. (Iris) (2018) Inconsistencies in clinical practice and guidelines: the management of asthma exacerbations in a New Zealand Emergency Department. thesis, Medicine.
Full text available on request.Abstract
Abstract Abstract Background: Salbutamol is the treatment of choice in asthma exacerbations, however, there is a lack of evidence and conflicting guidelines on the preferred dose. Moreover, it is unclear what recommendations are being followed by current clinical practice. We collected data to evaluate the current dosing of salbutamol for asthma exacerbations in an Emergency Department (ED) and compare this to the local and national guidelines. We aimed to determine predictors of hospital admission and to assess prehospital treatment and ED management. Methods: A retrospective study of 182 patients aged 16 to 65 years, presenting to the ED with an asthma exacerbation between 1 March 2017 and 15 October 2017. Primary outcomes were total dose of inhaled salbutamol given in the first 120 minutes, dose of inhaled salbutamol per treatment moment in the first 120 minutes and frequency of giving inhaled salbutamol in the first 60 minutes. Results: 122 patients provided data on inhaled salbutamol use. The mean total dose (mg) of inhaled salbutamol in the first 120 minutes was 3.5±1.7 (range 0.2 to 6.6). 85.4% of patients received 1.2mg salbutamol via metered dose inhaler (MDI) per treatment moment, compared to 8.5% receiving 0.6mg via MDI. 70% of patients received 5.0mg via nebulised therapy per treatment moment and 16.7% 2.5mg. The remaining 6.1% (MDI) and 13.3% (nebuliser) received both or other doses. 73.8% received 3 salbutamol doses in the first 60 minutes, 25.4% 4 doses and 0.8% received 5 doses. Conclusion: There is a wide range in salbutamol dosing regimens in the ED, with most patients receiving a relatively high dose of salbutamol via both MDI and nebulised therapy. This practice is not evidence based, nor recommended by national and international guidelines.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Kocks, dr. J.W.H. |
| Supervisor name: | Second supervisor: and Semprini, Dr. A. and Medical Research Institute of New Zealand (MRINZ) and Department: Respiratory & Emergency Medicine and Wellington, New Zealand |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1328 |
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