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OBJECTIVE: This 15-month retrospective study was designed to describe high flow nasal cannula (HFNC) utilization by our critical care transport (CCT) team and to track escalations in respiratory support within 24 hours of hospital admission. METHODS: Data was collected from January 1, 2019, to March 31, 2020; 6,279 pediatric transports completed during this time. Inclusion criteria: >30 days and < 18 years old, required HFNC ≥ 4 L/min during transport, and admitted to CMH. SARS-COVID-19 patients were excluded. All patients used standard high flow equipment; no new equipment trialed. We tracked high flow status based on if the transport team initiated the device, the referral initiated it but the team weaned it, or if the referral initiated it but team continued the settings. RESULTS: 382 charts reviewed; 358 patients met inclusion criteria. Median age 0.7 years old, with an interquartile range (IQR) of 0.3-1 year of age. Median weight 8.4 kilograms (kg), IQR 6.2-11 kg. Median transport time 80 minutes (min), IQR 69-115 min. Most of our HFNC volume was initiated by the referral (78%). We transported (59%) back to the PICU and (41%) to Peds. Median HFNC 10 L/min with an IQR of 6-15 L/min appreciated at drop-off regardless of HFNC status (initiated by transport, weaned by transport, or continued referral settings) (p-value 0.122). Escalations of care were tracked up to 24 hours after patient drop-off. A total of 118 patients (33%) had an escalation of care; 90 (76%) required an increase in flow, 28 (24%) required non-invasive ventilation, and 0 (0%) required intubation within 24 hours. Escalations typically occurred within the first 6 hours after patient drop-off, 96 (27%), with a median HFNC 10.25 L/min, IQR 8-14 L/min. DISCUSSION: The number of PICU admissions was likely due to our institutions HFNC floor criteria: < 2 years of age, no comorbidities, suspected respiratory viral illness, max 2 L/kg and/or 15 L/min, ≤ 40% FiO2. The high number of escalations in liter flow after patient drop-off (~25% of high flow volume) was likely due to inpatient protocol to initiate at 2 L/kg or max of 15 L/min. In the future, we plan to implement a HFNC protocol for management guidelines during CCT while conducting further research and review. CONCLUSION: Our data suggests HFNC utilization in pediatric CCT is a safe modality for non-invasive oxygen delivery with minimal risk of escalation and no need for intubation.

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Analysis Of High Flow Nasal Cannula Utilization During Pediatric Critical Care Transport