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
Guzmán et al. (Sun,) studied this question.