• Folafoluwa O Odetola, Renee R Anspach, Yong Y Han, and Sarah J Clark.
• Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI; Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI. Electronic address: fodetola@med.umich.edu.
• J Crit Care. 2017 Feb 1; 37: 162-172.

PurposeTo investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care.MethodsInterviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao2)/Fio2 (32%), and inflation pressure (16%). Poor clinical response was signified by high OI, inflation pressure, and Fio2, and low Pao2/Fio2. At EP 1, 18 of 19 respondents would initiate high-frequency oscillatory ventilation, and 1 would transfer. At EP 2, 15 of 18 respondents would maintain high-frequency oscillatory ventilation, 9 of them calling to discuss transfer. All respondents would transfer if escalated therapies failed to reverse the patient's clinical deterioration.ConclusionInterhospital transfer of children in respiratory failure is triggered by poor response to escalation of locally available care modalities. This finding provides new insight into decision making underlying interhospital transfer of children with respiratory failure.Copyright © 2016 Elsevier Inc. All rights reserved.

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