Journal of Multidisciplinary Healthcare (Mar 2024)

Clinical Practice of High-Flow Nasal Cannula Therapy in ARDS Patients: A Cross-Sectional Survey of Respiratory Therapists

  • Alyami MM,
  • Aldhahir AM,
  • Alqarni AA,
  • Salwi KM,
  • Sarhan AM,
  • Almeshari MA,
  • Alobaidi NY,
  • Alqahtani JS,
  • Siraj RA,
  • Alsulayyim AS,
  • Alghamdi SM,
  • Alasimi AH,
  • Alqarni OA,
  • Majrshi MS,
  • Alwafi H

Journal volume & issue
Vol. Volume 17
pp. 1401 – 1411

Abstract

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Mohammed M Alyami,1 Abdulelah M Aldhahir,2 Abdullah A Alqarni,3,4 Khalid M Salwi,1 Abdullah M Sarhan,1 Mohammed A Almeshari,5 Nowaf Y Alobaidi,6,7 Jaber S Alqahtani,8 Rayan A Siraj,9 Abdullah S Alsulayyim,2 Saeed M Alghamdi,10 Ahmed H Alasimi,11 Omar A Alqarni,10 Mansour S Majrshi,12,13 Hassan Alwafi14 1Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia; 2Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 4Respiratory Therapy Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 5Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 6Respiratory Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia; 7King Abdullah International Medical Research Center, Alahsa, Saudi Arabia; 8Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 9Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia; 10Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 11Department of Respiratory Therapy, Georgia State University, Atlanta, GA, USA; 12National Heart and Lung Institute, Imperial College London, London, UK; 13Respiratory Medicine, Royal Brompton Hospital, London, UK; 14Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi ArabiaCorrespondence: Abdulelah M Aldhahir, Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Al Maarefah Road, Jazan, 82911, Saudi Arabia, Tel +966557775561, Email [email protected]: High-flow nasal cannula (HFNC) is an essential non-invasive oxygen therapy in acute respiratory distress syndrome (ARDS) patients. Despite its wide use, research assessing the knowledge, practice, and barriers to using HFNC among respiratory therapists (RT) is lacking.Methods: A cross-sectional questionnaire was conducted among RTs in Saudi Arabia between December 19, 2022, and July 15, 2023. Data were analyzed as means and standard deviation or frequency and percentages. A Chi-square test was used to compare the differences between groups.Results: A total of 1001 RTs completed the online survey. Two-thirds of the respondents 659 (65.8%) had received training in using HFNC and 785 (78.4%) had used HFNC in clinical settings. The top conditions for HFNC indication were COVID-19 (78%), post-extubation (65%), and do-not-intubate patients (64%). Participants strongly agreed that helping maintain conversation and eating abilities (32.95%) and improving shortness of breath (34.1%) were advantages of HFNC. Surprisingly, 568 (57%) of RT staff did not follow a protocol for HFNC with ARDS patients. When starting HFNC, 40.2% of the participants started with FiO2 of 61% to 80%. Additionally, high percentages of RT staff started with a flow rate between 30 L/minute and 40 L/minute (40.6%) and a temperature of 37°C (57.7%). When weaning ARDS patients, 482 (48.1%) recommended first reducing gas flow by 5– 10 L/minute every two to four hours. Moreover, 549 (54.8%) believed that ARDS patients could be disconnected from HFNC if they achieved a flow rate of < 20 L/minute and FiO2 of < 35%. Lack of knowledge was the most common challenge concerning HFNC implementation.Conclusion: The findings revealed nuanced applications marked by significant endorsement in certain clinical scenarios and a lack of protocol adherence, underscoring the need for uniform, evidence-based guidelines and enhanced training for RTs. Addressing these challenges is pivotal to optimizing the benefits of HFNC across varied clinical contexts.Keywords: HFNC, Saudi Arabia, RT, respiratory therapy, ARDS, acute respiratory distress syndrome

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