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

Mohammed M Alyami; Abdulelah M Aldhahir; Abdullah A Alqarni; Khalid M Salwi; Abdullah M Sarhan; Mohammed A Almeshari; Nowaf Y Alobaidi; Jaber S Alqahtani; Rayan A Siraj; Abdullah S Alsulayyim; Saeed M Alghamdi; Ahmed H Alasimi; Omar A Alqarni; Mansour S Majrshi; Hassan Alwafi

doi:10.2147/JMDH.S454761

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

J Multidiscip Healthc. 2024 Mar 26:17:1401-1411. doi: 10.2147/JMDH.S454761. eCollection 2024.

Authors

Mohammed M Alyami¹, Abdulelah M Aldhahir², Abdullah A Alqarni^{3

4}, Khalid M Salwi¹, Abdullah M Sarhan¹, Mohammed A Almeshari⁵, Nowaf Y Alobaidi^{6

7}, Jaber S Alqahtani⁸, Rayan A Siraj⁹, Abdullah S Alsulayyim², Saeed M Alghamdi¹⁰, Ahmed H Alasimi¹¹, Omar A Alqarni¹⁰, Mansour S Majrshi^{12

13}, Hassan Alwafi¹⁴

Affiliations

¹ Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia.
² Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
³ Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
⁴ Respiratory Therapy Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
⁵ Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
⁶ Respiratory Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Alahsa, Saudi Arabia.
⁷ King Abdullah International Medical Research Center, Alahsa, Saudi Arabia.
⁸ Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia.
⁹ Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia.
¹⁰ Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.
¹¹ Department of Respiratory Therapy, Georgia State University, Atlanta, GA, USA.
¹² National Heart and Lung Institute, Imperial College London, London, UK.
¹³ Respiratory Medicine, Royal Brompton Hospital, London, UK.
¹⁴ Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia.

Abstract

Background: 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: ARDS; HFNC; RT; Saudi Arabia; acute respiratory distress syndrome; respiratory therapy.

Grants and funding

There is no financial supporting body for this study.