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Description and validation of a novel score (Flow Index) as a clinical indicator of the level of respiratory support to children on high flow nasal cannula.
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  • sandeep tripathi,
  • Jeremy Mcgarvey,
  • Nadia Shaikh,
  • Logan Meixsell
sandeep tripathi
University of Illinois College of Medicine at Peoria
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Jeremy Mcgarvey
OSF Saint Francis Medical Center
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Nadia Shaikh
University of Illinois College of Medicine at Peoria
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Logan Meixsell
OSF Saint Francis Medical Center
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Abstract

Objective: Describe & validate flow index (FiO2×flow rate/weight) to report the degree of respiratory support to children on high flow nasal cannula (HFNC) Methods: Retrospective chart review. Children managed with HFNC from 01/01/15 to 12/31/19. Variables included in the flow index (weight, FiO2, flow rate) and outcomes (hospital and ICU length of stay [LOS], escalation to the ICU) extracted from medical records. Max flow index defined by the earliest timestamp when patients FiO2×Flow rate was maximum. Step-wise regression used to determine the relationship between outcome (length of stay and escalation to ICU) and flow index Results: 1537 patients met the study criteria. Median 1st and maximum flow index of the population 24.1 and 38.1, respectively. Both 1st and maximum flow indexes showed a significant correlation with the LOS (r 0.25 and 0.31). 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 1st and max flow index derived using quartiles and showed significant age and diagnosis independent association with LOS. Patients with 1st flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (OR 2.39 and 8.08). The 1st flow index had a negative association with rapid response activation. Conclusions: Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC. High flow index associated with longer hospital LOS and the risk of escalation to ICU.