Implementing High-Flow Nasal Oxygen Therapy in Medical Wards: A Scoping Review to Understand Hospital Protocols and Procedures

Toby Thomas, Yet Hong Khor, Catherine Buchan and Natasha Smallwood ()
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Toby Thomas: Melbourne Medical School, University of Melbourne, Corner Grattan Street and Royal Parade, Melbourne 3010, Australia
Yet Hong Khor: Respiratory Research @Alfred, School of Translational Medicine, The Alfred Centre, Monash University, Melbourne 3004, Australia
Catherine Buchan: Respiratory Research @Alfred, School of Translational Medicine, The Alfred Centre, Monash University, Melbourne 3004, Australia
Natasha Smallwood: Respiratory Research @Alfred, School of Translational Medicine, The Alfred Centre, Monash University, Melbourne 3004, Australia

IJERPH, 2024, vol. 21, issue 6, 1-13

Abstract: Acute hypoxemic respiratory failure (ARF) is a common cause for hospital admission. High-flow nasal oxygen (HFNO) is increasingly used as a first-line treatment for patients with ARF, including in medical wards. Clinical guidance is crucial when providing HFNO, and health services use local health guidance documents (LHGDs) to achieve this. It is unknown what hospital LHGDs recommend regarding ward administration of HFNO. This study examined Australian hospitals’ LHGDs regarding ward-based HFNO administration to determine content that may affect safe delivery. A scoping review was undertaken on 2 May 2022 and updated on 29 January 2024 to identify public hospitals’ LHGDs regarding delivery of HFNO to adults with ARF in medical wards in two Australian states. Data were extracted and analysed regarding HFNO initiation, monitoring, maintenance and weaning, and management of clinical deterioration. Of the twenty-six included LHGDs, five documents referenced Australian Oxygen Guidelines. Twenty LHGDs did not define a threshold level of hypoxaemia where HFNO use was recommended over conventional oxygen therapy. Thirteen did not provide target oxygen saturation ranges whilst utilising HFNO. Recommendations varied regarding maximal levels of inspired oxygen and flow rates in the medical ward. Eight LHGDs did not specify any system to identify and manage deteriorating patients. Five LHGDs did not provide guidance for weaning patients from HFNO. There was substantial variation in the LHGDs regarding HFNO care for adult patients with ARF in Australian hospitals. These findings have implications for the delivery of high-quality, safe clinical care in hospitals.

Keywords: high-flow nasal oxygen; acute respiratory failure; policy; protocol; guideline (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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