• Jie Li, Meilien Tu, Lei Yang, Guoqiang Jing, James B Fink, Chris Burtin, AndradeArmèle Dornelas deADFederal University of Pernambuco, Recife, Brazil., Lingyue Gong, Lixin Xie, and Stephan Ehrmann.
• Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University, Chicago, Illinois. Jie_Li@rush.edu xielx301@126.com.
• Respir Care. 2021 Sep 1; 66 (9): 141614241416-1424.

BackgroundHigh-flow nasal cannula (HFNC) oxygen therapy has been broadly used. However, no consensus has been achieved on the practical implementation of HFNC and how to provide aerosol delivery during HFNC therapy in adult patients.MethodsAn online anonymous questionnaire survey endorsed by 4 academic societies from America, Europe, mainland China, and Taiwan was administered from May to December 2019. Clinicians who had worked in adult ICUs for > 1 year and had used HFNC to treat patients within 30 days were included.ResultsA total of 2,279 participants clicked on the survey link, 1,358 respondents completed the HFNC section of the questionnaire, whereas 1,014 completed the whole survey. Postextubation hypoxemia and moderate hypoxemia were major indications for HFNC. The initial flow was mainly set at 40-50 L/min. Aerosol delivery via HFNC was used by 24% of the participants (248/1,014), 30% (74/248) of whom reported reducing flow during aerosol delivery. For the patients who required aerosol treatment during HFNC therapy, 40% of the participants (403/1,014) reported placing a nebulizer with a mask or mouthpiece while pursuing HFNC whereas 33% (331/1,014) discontinued HFNC to use conventional aerosol devices. A vibrating mesh nebulizer was the most commonly used nebulizer (40%) and was mainly placed at the inlet of the humidifier.ConclusionsThe clinical utilization of HFNC was variable, as were indications, flow settings, and criteria for adjustment. Many practices associated with concomitant aerosol therapy were not consistent with available evidence for optimal use. More efforts are warranted to close the knowledge gap.Copyright © 2021 by Daedalus Enterprises.

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