High-flow nasal cannula therapy: A multicentred survey of the practices among physicians and respiratory therapists in Singapore |
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| Affiliation: | 1. Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore;2. Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore;3. Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore;4. Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore;5. Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore;6. Department of Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore;7. Division of Critical Care, National University Hospital, National University Health System, Singapore;8. Department of Anaesthesia, National University Hospital, National University Health System, Singapore;9. Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore;10. Department of Cardiology, Tan Tock Seng Hospital, Singapore;1. Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia;2. Wellcome-Wolfson Institute for Experimental Medicine, Queen''s University Belfast, United Kingdom;3. Lane Fox Clinical Respiratory Physiology Research Centre, Guy''s and St. Thomas'' NHS Foundation Trust, London, United Kingdom;4. Centre for Human and Applied Physiological Sciences, King''s College London, United Kingdom;5. Department of Physiotherapy, The University of Melbourne, Melbourne, Australia;1. Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia;2. Department of Neurosciences, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia;3. Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia;4. School of Medicine, Deakin University, Victoria, Australia;1. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Level 3, 555 St Kilda Rd, Melbourne, VIC, 3004, Australia;2. Nutrition and Dietetics Department, Box Hill Hospital, Eastern Health, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia;3. Nutrition Department, Alfred Hospital, Alfred Health, 55 Commercial Road, Melbourne, VIC, 3004, Australia;1. Discipline of Physiotherapy, University of Canberra, Australia;2. Physiotherapy Department, John Hunter Hospital, Newcastle, Australia;3. Department of Rehabilitation Sciences, KU Leuven, Belgium;4. Physiotherapy Department, Launceston General Hospital, Launceston, Australia;5. School of Medicine, University of Tasmania, Australia;6. Canberra Hospital and Health Services, Canberra, Australia;7. Physiotherapy Department, Canberra Hospital, Australia |
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| Abstract: | BackgroundUse of high-flow nasal cannula (HFNC) has become a regular intervention in the intensive care units especially in patients coming in with hypoxaemic respiratory failure. Clinical practices may differ from published literature.ObjectivesThe objective of this study was to determine the clinical practices of physicians and respiratory therapists (RTs) on the use of HFNC.MethodsA retrospective observational study looking at medical records on HFNC usage from January 2015 to September 2017 was performed and was followed by a series of questions related to HFNC practices. The survey involved physicians and RTs in intensive care units from multiple centres in Singapore from January to April 2018. Indications and thresholds for HFNC usage with titration and weaning practices were compared with the retrospective observational study data.ResultsOne hundred twenty-three recipients (69.9%) responded to the survey and reported postextubation (87.8%), pneumonia in nonimmunocompromised (65.9%), and pneumonia in immunocompromised (61.8%) patients as the top three indications for HFNC. Of all, 39.8% of respondents wanted to use HFNC for palliative intent. Similar practices were observed in the retrospective study with the large cohort of 63% patients (483 of the total 768 patients) where HFNC was used for acute hypoxaemic respiratory failure and 274 (35.7%) patients to facilitate extubation. The survey suggested that respondents would initiate HFNC at a lower fraction of inspired oxygen (FiO2), higher partial pressure of oxygen to FiO2 ratio, and higher oxygen saturation to FiO2 ratio for nonpneumonia patients than patients with pneumonia. RTs were less likely to start HFNC for patients suffering from pneumonia and interstitial lung disease than physicians. RTs also preferred adjustment of FiO2 to improve oxygen saturations and noninvasive ventilation for rescue.ConclusionsAmong the different intensive care units surveyed, the indications and thresholds for the initiation of HFNC differed in the clinical practices of physicians and RTs. |
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| Keywords: | Survey High-flow nasal cannula Respiratory failure Weaning High-flow nasal cannula failure |
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