Acute Asthma Exacerbation Clinical Pathway – PICU – Determine Severity Level of Asthma Exacerbation

Acute Asthma Exacerbation Clinical Pathway – PICU

Determine Severity Level of Asthma Exacerbation

  • Assessment is obtained in the setting of failed pre-ICU therapies
  • Respiratory therapist partners with bedside nurse to document in Asthma flowsheet every hour

Key Exam Elements (PASS: Pediatric Asthma Severity Score)

  Moderate Severe Critical Impending Respiratory Failure
Wheezing None or mild (0)
None or end of expiration only		 Moderate (1)
Throughout expiration		 Severe (2)
Inspiratory/expiratory or absent due to poor air exchange		 Diminished due to poor air exchange
Work of Breathing None or mild (0)
Normal or minimal retractions		 Moderate (1)
Intercostal retractions		 Severe (2)
Suprasternal retractions, abdominal breathing		 Tiring, inability to maintain work of breathing
Prolonged Expiration None or mild (0)
Normal or minimally prolonged		 Moderate (1) Severe (2) Severely prolonged

Other Exam Elements (Not Assessed in PASS)

  Moderate Severe Critical Impending Respiratory Failure
Breath Sounds/ Aeration Decreased at bases Widespread decrease Widespread decrease Absent/minimal
Talks In Phrases Words Words/refuses  
Alertness May be agitated Agitated Agitated or drowsy Obtunded or combative

Symptoms

  Moderate Severe Critical Impending Respiratory Failure
Breathlessness While at rest
For infants:
Soft or shorter cry
Difficulty feeding
Prefers sitting		 While at rest
For infants:
Stops feeding
Sits upright		 While at rest
Tripod positioning
For infants:
Stops feeding
Sits upright		  

FiO2 Requirement for SPO2 > 92%

  Moderate Severe Critical Impending Respiratory Failure
FiO2 Requirement ≤ 50% ≤ 50% > 50% Variable

Guide to Breathing and Heart Rates in Awake Children

Age Normal Respiratory Rate
(per Minute)		 Normal Heart Rate
(per Minute)
< 2 mos < 60 < 160
2–12 mos < 50 < 160
1–2 yrs < 40 < 120
2–5 yrs < 40 < 110
6–8 yrs < 30 < 110