PDF(Pubmed)
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.
摘要：
急性低氧性呼吸衰竭（ARF）是住院的常见原因。高流量鼻氧（HFNO）越来越多地用作ARF患者的一线治疗，包括医疗病房。提供HFNO时，临床指导至关重要，和卫生服务使用当地卫生指导文件（LHGD）来实现这一目标。尚不清楚LHGD医院对HFNO的病房管理有何建议。这项研究检查了澳大利亚医院LHGD关于基于病房的HFNO管理的内容，以确定可能影响安全分娩的内容。2022年5月2日进行了范围审查，并于2024年1月29日进行了更新，以确定在澳大利亚两个州的医疗病房中向患有ARF的成年人提供HFNO的公立医院。提取并分析了有关HFNO起始的数据，监测,保养和断奶,和临床恶化的管理。在包括LHGD的26个中，五份文件引用了澳大利亚氧气指南。20个LHGD没有定义低氧血症的阈值水平，建议使用HFNO而不是常规氧疗。13在使用HFNO时没有提供目标氧饱和度范围。关于病房中最大吸入氧气水平和流速的建议各不相同。八个LHGD没有指定任何系统来识别和管理恶化的患者。五个LHGD没有为HFNO的断奶患者提供指导。在澳大利亚医院中，对于成人ARF患者的HFNO护理，LHGD存在很大差异。这些发现对高质量的交付，医院的安全临床护理。
