Tripathi Sandeep, Mcgarvey Jeremy S, Shaikh Nadia, Meixsell Logan J
Department of Pediatrics, OSF HealthCare Children's Hospital of Illinois, Illinois, United States.
Healthcare Analytics, OSF Healthcare Children's Hospital of Illinois, Peoria, Illinois, United States.
J Pediatr Intensive Care. 2021 Jun 26;12(3):173-179. doi: 10.1055/s-0041-1731021. eCollection 2023 Sep.
This study's objective was to describe and validate flow index (flow rate × FiO /weight) as a method to report the degree of respiratory support by high flow nasal cannula (HFNC) in children. We conducted a retrospective chart review of children managed with HFNC from January 1, 2015 to December 31, 2019. Variables included in the flow index (weight, fraction of inspired oxygen [FiO ], flow rate) and outcomes (hospital and intensive care unit [ICU] length of stay [LOS], escalation to the ICU) were extracted from medical records. Max flow index was defined by the earliest timestamp when patients FiO × flow rate was maximum. Step-wise regression was used to determine the relationship between outcome (LOS and escalation to ICU) and flow index. Fifteen hundred thirty-seven patients met the study criteria. The median first and maximum flow indexes of the population were 24.1 and 38.1. Both first and maximum flow indexes showed a significant correlation with the LOS ( = 0.25 and 0.31, < 0.001). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of first and max flow index were derived using quartiles, and they showed significant age and diagnosis independent association with LOS. Patients with first flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (odds ratio: 2.39 and 8.08). The first flow index had a negative association with rapid response activation. Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC.
本研究的目的是描述并验证流量指数（流速×吸入氧分数/体重）作为报告儿童高流量鼻导管（HFNC）呼吸支持程度的一种方法。我们对2015年1月1日至2019年12月31日期间接受HFNC治疗的儿童进行了回顾性病历审查。从病历中提取流量指数（体重、吸入氧分数[FiO₂]、流速）和结局（住院和重症监护病房[ICU]住院时间[LOS]、转入ICU）所包含的变量。最大流量指数由患者FiO₂×流速最大时的最早时间戳定义。采用逐步回归来确定结局（LOS和转入ICU）与流量指数之间的关系。1537名患者符合研究标准。该人群的首次和最大流量指数中位数分别为24.1和38.1。首次和最大流量指数均与LOS显著相关（r分别为0.25和0.31，P<0.001）。该指数的相关性强于用于计算它的变量，在控制年龄、种族、性别和诊断后仍具有显著性。根据四分位数得出首次和最大流量指数的轻度、中度和重度类别，它们与LOS显示出显著的年龄和诊断独立相关性。首次流量指数>20且最大流量指数>59.5的患者转入ICU的比值比增加（比值比分别为2.39和8.08）。首次流量指数与快速反应激活呈负相关。流量指数是评估接受HFNC治疗的儿童呼吸支持程度的有效指标。
