The "8 D's" of High-Flow Nasal Cannula Risk: A Scoping Review.

Abstract

Background: High-flow nasal cannula oxygen therapy is commonly used in acute respiratory failure. Despite this therapy's benefits, it also has risks, with therapy failure and intubation delay cited most frequently. Awareness of these risks is important to ensure optimal patient care and guide future research.

Objective: To explore risk representation in the literature for acutely ill adult patients receiving high-flow nasal cannula therapy.

Methods: A scoping review was performed using the Joanna Briggs Institute method of evidence synthesis. An a priori search strategy and protocol were carried out using the PubMed, Embase, CINAHL Complete, and medRxiv databases. After primary screening, data were collected using the REDCap (Research Electronic Data Capture) tool. Data were prepared, analyzed, and presented using Jupyter Notebook (Python 3.9.7). An online data repository was created to host the associated datasets for future work.

Results: Primary screening of the 2975 results led to exclusion of 2272 records. After duplicate and redundant articles were removed, articles underwent full-text review, yielding 343 included articles. The most frequently implicated disease in high-flow nasal cannula research was COVID-19 (n = 145), with publication frequency peaking in 2022 (n = 110). All risks fell under 8 categories: deterioration, death, device-related events, delay, disposition, debility, distress, and dysphagia (the "8 D's").

Conclusion: Acutely ill patients receiving high-flow nasal cannula therapy encounter 8 categories of risk. Deterioration and death are the most often discussed. Device-related events, delay, disposition, debility, and distress warrant further study.