ABSTRACT 397

Abstract

Background and aims: The BTS asthma guideline has been available since 2008. The North West and North Wales Paediatric Transport Team (NWTS) introduced a guideline for the management of acute severe asthma in February 2013. This has since been available on the NWTS website and has been part of ongoing outreach education. Aims: To assess the impact of NWTS asthma guideline. Methods: Retrospective audit of NWTS database for ‘asthma’ patients and case note review with limited electronic access to PICU letters and case summaries for these patients. Previous audit data was used for comparison. Results: 36 Patients were identified out of 888 referrals (4%). 18 were managed locally, 6 transferred to HDU and 12 to PICU. 12 patients accounted for a total of 46 PICU bed days. 20% of all lactate measurements recorded were > 4 mmol/l.Table: No title available.Conclusions: Data so far support the notion that introduction of the guideline has optimised pre-intubation bronchodilator therapy in these patients and also contributed to lesser morbidity, with more patients avoiding intubation and/or transfer to regional PICU. There were no peri-intubation air leaks or deaths in this patient group. We also feel that this guideline has encouraged earlier referral, supported by the reduction in number of patients intubated at time of referral. Significant lactic acidaemia was noted in subgroup of patients which is likely to be related to bronchodilator therapy. Further data gathering is in progress to ascertain if the raised lactate values influence the decision to administer fluid boluses to these patients.