30-Flow Index: A Novel Method to Report the Respiratory Support for Children on High-Flow Nasal Cannula
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Pediatrics, Pulmonary, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Sandeep Tripathi

Introduction/Hypothesis: High flow nasal cannula (HFNC) provides support to breathing by flow rate and FiO2. The weight of the patient impacts the degree of support. We devised a scoring system to report the degree of support using one number (flow rate×FiO2/weight). This retrospective chart review was conducted to validate this scoring system (flow Index, FI) in its ability to quantify and predict disease severity and outcome.

Methods: Children who were managed with HFNC in the hospital from 01/2015 to 11/2019 were identified from electronic medical records. Patients demographics and values of initial and max FI and index just prior to the ICU transfer were extracted from EMR. Patients that were missing in data points required to calculate the FI were excluded. Simple regression was used to determine the relationship between the outcome (length of stay, LOS) and individual components of the index and index itself. Multiple regression was performed to adjust for confounding variables. Statistical analysis was performed using R (v 4.0.0).

Results: 1537 patients met study criteria. The median age was 20 months, and the median duration on HFNC was 45 hours. 80.6% had a respiratory diagnosis. Median, initial, and max FI were 24.1 and 38.1, respectively. On simple linear regression, first and Max value of the score showed a significant correlation with LOS (r 0.25 and 0.31, p <0.001). The correlation for the index was stronger than the coefficients of the variables used to calculate them. FI remains significantly associated with increased LOS after controlling for other variables, including diagnoses and age. Patients in the 3rd and 4th quartile of the initial FI (24.1 – 42.9 and > 42.9) and patients in 2nd /3rd and 4th quartile for the max FI (20.6 – 38.1, 38.1 – 64.7 and > 64.7) had significantly higher LOS compared to patients on the 1st quartile. There was a significant -ve interaction between the FI and age (b= -0.004, p <0.001), indicating the difference in LOS for patients in the higher FI group decreases with age. Of the 195 patients who met the inclusion criteria for escalation of care to ICU, there was no significant correlation of FI with ICU length of stay.

Conclusions: Flow index (FI) is a valid measure to assess the severity of illness. Respiratory support can be categorized based on FI Quartiles.



Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Pulmonary
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Oxygenation
Tag Ventilation
Year 2021
flow index
respiratory support
high flow nasal cannula
hospital length of stay
ICU transfers


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