(1199) Perceptions Regarding Pain and Comfort for Pediatric Continuous Albuterol Delivery Interfaces

Sunday, February 23, 2025

11:00am – 12:00pm Eastern Time

Location: Connections Central - RST 16

First Author(s)

Brett W. Russi, MD

University of South Florida Morsani College of Medicine
Saint Petersburg, Florida, USA

Co-Author(s)

Alexa R. Roberts, MD (she/her/hers)

St. Petersburg, Florida, United States
KD

Kristina K. Darville, DNP, APRN, CPNP-AC

Nurse Practitioner, Pediatric Critical Care Medicine
Johns Hopkins All Children's Hospital, United States
PS

Peter Scully, MD

Assistant Professor, Pediatric Critical Care Medicine. Associate Director, Pediatric Critical Care M
McGovern Medical School at UT Health, United States
Anthony A. Sochet, MD,

Johns Hopkins All Childrens Hospital
St Petersburg, Florida, USA

Introduction: Continuous nebulized albuterol is routinely administered via a simple mask (SM) or bilevel positive airway pressure (BiPAP) for cases with pediatric critical asthma. Recently, heated, humidified, high-flow nasal cannula (HFNC) has gained popularity due to a perception of improved patient comfort as compared to other interfaces, but this has not been validated. We aim to prospectively compare patient pain (i.e., FLACC Pain Scale) and comfort (i.e., COMFORT-B Scale) data related to albuterol delivery interfaces reported by parents, bedside nurses, and clinicians for children with critical asthma. We hypothesize variation in comfort and pain data by albuterol delivery interface will exist by respondent and that healthcare providers, as compared to parents, will underestimate pain and discomfort.

Methods: We performed a prospective, single-center cohort study of children 3-17 years of age hospitalized for critical asthma from November 2023-July 2024 prescribed continuous albuterol. Cohorts were defined by albuterol delivery interface. Primary outcomes were paired FLACC Pain and COMFORT-B scores from parent/caregiver, bedside nursing, and clinical providers. Descriptive data including demographics, anthropometrics, asthma severity indices, interventions applied, and clinical trajectory data. Summative and comparative statistics were employed by albuterol interface and respondent type.

Results: Of 42 children studied, 28 received albuterol via SM, 12 via BiPAP, and 2 via HFNC. Comparable demographics, anthropometrics, severity of illness indices, clinical interventions, and clinical outcomes were observed by albuterol interface cohorts. Comfort-B data were not detectably different between respondent type or by albuterol interface. Compared to healthcare providers, parents reported greater median FLACC scores overall (3 [IQR:0-4] vs 0 [IQR:0-0]), for the SM group (3 [IQR:0-4] vs 0 [IQR:0-0]), and for the HFNC group (5 [IQR:4-6] vs 0 [IQR:0-2]) (all p< 0.05).

Conclusions: Our preliminary findings suggest incongruity regarding perceptions of pain related to albuterol delivery interfaces between parents and healthcare providers for children hospitalized with critical asthma. Upon further validation, these data offer opportunities to partner with families to optimize patient experience.