title: Interhospital transfer of children in respiratory failure: a clinician interview qualitative study.
abstract: To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care.
  
  
  
  Interviews 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.
  
  
  
  Interhospital 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.
authors.affiliation: 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.
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
authors.affiliation: Department of Sociology, University of Michigan, Ann Arbor, MI.
authors.forename: Renee R
authors.initials: RR
authors.lastname: Anspach
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
authors.forename: Yong Y
authors.initials: YY
authors.lastname: Han
authors.affiliation: Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services; D003422:Critical Care; D003657:Decision Making; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008824:Michigan; D010360:Patient Transfer; D010818:Practice Patterns, Physicians'; D012131:Respiratory Insufficiency / Q000628:therapy*
keywords: Child; Critical illness; Intensive care units; Interview; Patient transfer; Therapeutics