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Research Snapshot Theater: Pulmonary, Pediatric IV

Bedside Extubation Checklist Lowers High-Flow Nasal Cannula Use and Supply Costs in a Pediatric ICU

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 13
  • PG

    Pedro J. Guzman, MD (he/him/his)

    Cleveland Clinic Children's Hospital, Ohio

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • CE

    Chidiebere Ezetendu, n/a

    Associate Staff, Pediatric Critical Care Medicine
    Cleveland Clinic Children's, Ohio

    Disclosure information not submitted.

  • NS

    Nicole Saliba, n/a

    Supervisor, Pediatric Respiratory Therapy
    Cleveland Clinic Children's, Ohio

    Disclosure information not submitted.

  • KF

    Kathy Fedor, n/a

    Manager, Pediatric Respiratory Therapy
    Cleveland Clinic Children's, Ohio

    Disclosure information not submitted.

Introduction: Post-extubation interface selection varies widely in pediatric intensive care units (PICU). High-flow nasal cannula (HFNC) is frequently used but may contribute to unnecessary supply costs and prolonged length of stay (LOS) when applied liberally. We implemented a bedside extubation interface checklist and hypothesized that its adoption would reduce HFNC use, lower HFNC-related supply cost, and decrease post-extubation PICU LOS without increasing respiratory-support escalation


Methods: We conducted a single-center, before-and-after study comparing extubations from November 2023-May 2024 with those from November 2024-May 2025. The primary outcome was reduction in HFNC utilization and its related supply cost. Secondary outcomes were post-extubation PICU LOS and respiratory-support escalation within 48 hours. Continuous variables were summarized by median and compared with the Wilcoxon rank-sum test; mean LOS, total bed-hours, and total/percent cost savings were calculated descriptively. Categorical outcomes were analyzed with a two-sample proportion z-test for HFNC utilization and a Fisher's exact test for escalation (small cell counts). Analyses were performed in Stata 16


Results: HFNC utilization declined from 34.7% (25/72) to 22.0% (11/50) after checklist implementation. Median per-patient HFNC supply cost fell from $116 to $51 (Wilcoxon p=0.13), yielding $1631 in cumulative savings over seven months (-56%). Respiratory-support escalation remained rare (4.2% vs 2.0%; p=0.64). Median post-extubation PICU LOS was unchanged at 24h in both groups (p=0.36); however, mean LOS decreased by 12h per patient (from 61h to 49h), yielding 1942 fewer PICU bed-hours, equivalent to a 19% per-patient and 44% overall reduction in bed occupancy


Conclusions: Checklist-guided extubation interface selection was associated with a reduced HFNC supply cost, lower HFNC use, and PICU bed-hours without increasing respiratory-support escalation. Although these differences did not reach statistical significance, the deffect sizes are clinically meaningful. Prospective validation in larger, multicenter cohorts is warranted to confirm benefit and advance cost-effective, value-based pediatric critical care