Asthma, PICU — Determine Severity Level of Asthma Exacerbation — Clinical Pathway: Inpatient and ICU

Acute Asthma Exacerbation Clinical Pathway — PICU

Determine Severity Level of Asthma Exacerbation

  • Assessment is obtained in the setting of failed pre-ICU therapies
  • This metric should not be used for noncritically ill patients
  • Respiratory therapist to assess and document in an Epic flowsheet every hour

Key Exam Elements (PASS: Pediatric Asthma Severity Score)

  Moderate Severe Critical Impending Respiratory Arrest
Wheezing Moderate (1)
Throughout expiration		 Severe(2)
Inspiratory & expiratory or absent due to poor aeration		 Severe (2)
Inspiratory & expiratory or absent due to poor aeration		 Diminished or absent due
to poor aeration
Work of breathing Moderate (1)
Intercostal retractions		 Severe (2)
Suprasternal retractions, abdominal breathing		 Severe (2)
Suprasternal retractions, abdominal breathing		 Tiring, inability to maintain
work of breathing
Prolonged expiration Moderate (1) Severe (2) Severe (2) Severe, difficult to assess in setting of poor aeration

Other Exam Elements (not assessed in PASS)

  Moderate Severe Critical Impending Respiratory Arrest
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
GCS: Eyes Normal spontaneous (4)
If sleeping, responsive to voice may be normal (3)		 Normal spontaneous (4)
If sleeping, responsive to voice may be normal (3)		 Normal spontaneous (4)
If sleeping, responsive to voice may be normal (3)		 Responsive to pain (2)
Unresponsive (1)
Decline in score most worrisome

Symptoms

  Moderate Severe Critical Impending Respiratory Arrest
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 > 90% (Hypoxemia)

  Moderate Severe Critical Impending Respiratory Arrest
FiO2 Requirement ≤ 50% ≤ 50% Variable Variable

Guide to Breathing and Heart Rates in Awake Children

Age Normal Respiratory Rate
(per Minute)		 Normal Heart Rate
(per Minute)
< 2 months < 60 < 160
2-12 months < 50 < 160
1-2 years < 40 < 120
2-5 years < 40 < 110
6-8 years < 30 < 110