Alyami Mohammed M, Aldhahir Abdulelah M, Alqarni Abdullah A, Salwi Khalid M, Sarhan Abdullah M, Almeshari Mohammed A, Alobaidi Nowaf Y, Alqahtani Jaber S, Siraj Rayan A, Alsulayyim Abdullah S, Alghamdi Saeed M, Alasimi Ahmed H, Alqarni Omar A, Majrshi Mansour S, Alwafi Hassan
Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia.
Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.
J Multidiscip Healthc. 2024 Mar 26;17:1401-1411. doi: 10.2147/JMDH.S454761. eCollection 2024.
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.
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.
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 FiO 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 FiO of <35%. Lack of knowledge was the most common challenge concerning HFNC implementation.
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.
高流量鼻导管（HFNC）是急性呼吸窘迫综合征（ARDS）患者重要的无创氧疗方式。尽管其应用广泛，但缺乏评估呼吸治疗师（RT）对HFNC的知识、实践及使用障碍的研究。
于2022年12月19日至2023年7月15日在沙特阿拉伯的呼吸治疗师中进行了一项横断面问卷调查。数据以均值和标准差或频率及百分比进行分析。采用卡方检验比较组间差异。
共有1001名呼吸治疗师完成了在线调查。三分之二的受访者659名（65.8%）接受过HFNC使用培训，785名（78.4%）在临床环境中使用过HFNC。HFNC适应症的首要情况是新冠病毒病（78%）、拔管后（65%）和拒绝插管患者（64%）。参与者强烈认同帮助维持交谈和进食能力（32.95%）以及改善呼吸急促（34.1%）是HFNC的优势。令人惊讶的是，568名（57%）RT工作人员在治疗ARDS患者时未遵循HFNC方案。开始使用HFNC时，40.2%的参与者起始吸氧浓度为61%至80%。此外，高比例的RT工作人员起始流速在30升/分钟至40升/分钟之间（40.6%），温度为37°C（57.7%）。在为ARDS患者撤机时，482名（48.1%）建议每两至四小时先将气体流速降低5 - 10升/分钟。此外，549名（54.8%）认为如果ARDS患者的流速<20升/分钟且吸氧浓度<35%，就可以脱离HFNC。知识缺乏是HFNC实施方面最常见的挑战。
研究结果揭示了在某些临床场景中得到显著认可但缺乏方案依从性的细微差别应用，强调了需要统一的、基于证据的指南以及加强对呼吸治疗师的培训。应对这些挑战对于在不同临床环境中优化HFNC的益处至关重要。
