Abstract
BACKGROUND AND AIMS: High-flow nasal cannula (HFNC) is increasingly utilized in clinical practice; however, the perspectives of physicians on its use and associated barriers in managing acute respiratory distress syndrome (ARDS) in Saudi Arabia remain unexplored. This study aims to evaluate HFNC practices and identify the barriers faced by ICU and respiratory physicians in utilizing HFNC for ARDS patients. METHODS: A cross-sectional survey was distributed between December 22, 2022, and July 15, 2023, to respiratory and ICU physicians in Saudi Arabia. Data are presented as frequencies and percentages. RESULTS: A total of 987 responses were analyzed, revealing that physicians perceive HFNC as beneficial for relieving shortness of breath (686, or 69.5%), helping with speech and eating (649, or 65.8%), and potentially preventing intubation (629, or 63.7%). In terms of HFNC practice, 445 respondents (45.1%) reported that its use is governed by institutional protocols, while 679 (68.8%) indicated that the decision to initiate therapy is made by physicians. Additionally, 458 (46.4%) stated that a flow rate of ≥ 15 L/min is necessary to start HFNC therapy. When considering initial settings, nearly half (455, or 46.09%) chose a fraction of inspired oxygen (FiO(2)) between 61%-80%, 442 (44.8%) chose a flow between 30 and 40 L/min, and 476 (48.23%) chose a temperature of 34°C. Reducing gas flow by 5-10 L/min every two to 4 h was the most appropriate way of weaning, according to 407 (41.24%), and both FiO(2) < 35% and gas flow < 20 L/min should be achieved to disconnect HFNC therapy. Lack of knowledge about HFNC therapy was the most commonly reported barrier (494, or 50.1%). CONCLUSION: Physicians demonstrated a comprehensive understanding of the potential benefits associated with HFNC therapy. However, variations in initial settings and the absence of standardized guidelines present significant challenges to its optimal application in patients with ARDS.