Delivery of Continuous Albuterol During Pediatric Emergency Medical Services Transport

Background: Severe asthma exacerbation is treated with continuous albuterol. Little is known regarding the use of continuous albuterol during emergency medical transport. Our pediatric inter-facility transport service changed from using a large volume (LVN) to vibrating mesh (VMN) to administer continuous albuterol. The aim of this study was to evaluate the effect of the practice change on patient outcomes. We hypothesized that outcomes will be similar regardless of the device used. Methods: A retrospective review of children with asthma treated with continuous albuterol during inter-facility transport from June 1, 2018, to June 30, 2023. Children were grouped by type of nebulizer (LVN or VMN) used during transport for continuous albuterol. Primary outcomes were hospital stay and duration of continuous aerosol therapy, compared between groups by median regression with weighting to account for differences between transport nebulizer groups. Secondary outcomes were use of respiratory support during continuous therapy, pediatric ICU, and intermediate care unit stay. Results: Ninety-eight children were included in the analysis. Median age was 6 (3–9) years. Fifty-two (53%) and 46 (47%) children received continuous albuterol during transport with an LVN or VMN, respectively. Weighted differences between VMN and LVN in median hospital stay and duration of continuous albuterol were −0.72 days ( P = .52) and −12.7 h ( P = .052), respectively. High-flow nasal cannula was used more often during transport when the VMN was used ( P < .001). Thirty-seven (80%) of children who utilized an LVN during transport were changed to a VMN upon admission. Their stay was longer than that of those who did not change to VMN. No adverse events were identified. Conclusions: Change in practice from an LVN to a VMN for administration of continuous albuterol during inter-facility transport was not associated with a change in stay or duration of continuous albuterol therapy.