Traditionally, high-flow oxygen therapy (HFOT) was defined as the delivery of a flow of oxygen higher than 6 L/min. Recently, however, a method has been described in which flows of up to 50 L/min are delivered through a nasal cannula with a heated humidifier that optimizes oxygen administration. HFOT improves oxygenation by various mechanisms, for instance by decreasing oxygen dilution, reducing respiratory dead space, and generating a continuous positive airway pressure effect. It may also have a beneficial effect on hemodynamics, exercise capacity, and comfort, especially when a nasal cannula is used. HFOT is now a viable treatment option because of the use of heated humidifiers, which allow delivery of conditioned inspiratory gases at 37°C and 100% humidity. Properly conditioned gas provides higher comfort and minimizes deterioration of nasopharyngeal structures. Various HFOT systems are currently available. It is important to use the most comfortable device for the patient in question, with the best gas conditioning.

High-flow Oxygen Therapy in Acute Respiratory Failure

Ischemic stroke represents 87% of all strokes.1 As worldwide initiatives move forward with stroke care, healthcare providers and institutions will be called on to deliver the most current evidence-based care. The American Heart Association/American Stroke Association (AHA/ASA) charged a panel of healthcare professionals from several disciplines with developing a practical, comprehensive overview of care for the patient with acute ischemic stroke (AIS). This article focuses on educating nursing and allied healthcare professionals about the roles and responsibilities of those who care for patients with AIS.

Nurses play a pivotal role in all phases of care of the stroke patient. For the purposes of this article, the writing panel has defined 2 phases of stroke care: (1) The emergency or hyperacute care phase,2,3 which includes the prehospital setting and the emergency department (ED), and (2) the acute care phase, which includes critical care units, intermediate care units, stroke units, and general medical units.

Stroke is a complex disease that requires the efforts and skills of all members of the multidisciplinary team. Nurses are often responsible for the coordination of care throughout the continuum.4–9 Coordinated care of the AIS patient results in improved outcomes, decreased lengths of stay, and decreased costs.10

In developing this comprehensive overview, the writing panel applied the rules of evidence and formulation of strength of evidence (recommendations) used by other AHA writing groups11 (Table 1). We also cross-reference other AHA guidelines as appropriate. 



Table 1. Applying Classification of Recommendations and Levels of Evidence 

*Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. …

Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient A Scientific Statement From the American Heart Association

The nasal cannula has been a commonly used patient interface to provide supplemental oxygen since its introduction in the 1940s. Traditionally, it has been categorized as a low-flow device and capable of delivering a 0.4 F(IO(2)) with flows up to 6 L/min to adults with normal minute ventilation. However, there is considerable performance variability among patients and design, which results in an exponential decline in delivered F(IO(2)) as breathing frequencies increase. The nasal cannula has also been successfully adapted for use in perinatal and pediatric respiratory care; flows are reduced, in the range of 0.25-1 L/min, due to smaller minute volumes. A decade or so ago, high-flow nasal cannula (HFNC) oxygen therapy was introduced, accompanied by heated humidification systems to prevent the associated drying of upper airway mucosa and to increase patient comfort. Therapeutic flows for adults were in the 15-40 L/min range; F(IO(2)) could be independently adjusted with air/O(2) blending. The HFNC has also found additional clinical application in perinatal care, as delivery systems with flows > 2 L/min could create a distending pressure similar to nasal CPAP. There is a small but growing body of information from clinical trials that supports use of HFNC as an alternative oxygen interface for adults who present with moderate hypoxemia that persists after receiving oxygen by reservoir-bag masks or similar therapy. Clinical observations report greater patient acceptance and comfort versus oxygen masks. HFNC therapy has also been considered valuable in perinatal care in treating the respiratory distress syndrome or supporting patients after extubation similar to nasal CPAP. At present, research-based evidence for the role of HFNC for its perinatal applications remains unclear. This review will identify proposed mechanisms for therapeutic effectiveness, current delivery equipment, guidelines for rational patient application, and direction for further research.

http://rc.rcjournal.com/content/respcare/58/1/98.full.pdf

High-Flow Oxygen Administration by Nasal Cannula for Adult and Perinatal Patients

BACKGROUND: Generally, families of critical care patients are not actively involved in the patients' care in meaningful ways. A family-centered care model formalizes each patient and the patient's family as the unit of care. Family-centered care comprises 3 concepts: respect, collaboration, and support. OBJECTIVE: To evaluate the effects on family-centered care of having critical care nurses partner with patients' families to provide fundamental care to patients. METHODS: At the control site, patients' families experienced usual care; at the intervention site, patients' families were invited to assist with some of their relative's fundamental care with nurses' support. The family-centered care survey was used to measure families' perceptions of respect, collaboration, support, and overall family care at baseline and 48 hours later. Multivariate logistic regression was used to determine independent predictors of scores. RESULTS: A total of 174 family members of patients participated (75 control, 99 intervention). Total median scores on the survey were 3.2 (control) and 3.2 (intervention) at baseline and 3.2 (control) and 3.5 (intervention) at follow-up. After adjustments in the multivariate model, the family-centered care intervention was the strongest predictor of scores at 48 hours (odds ratio [OR]=1.66; P<.001). Other independent predictors included relatives with previous critical care experience (OR=1.27; P=.006) and those who were partners of the patient (OR=1.33; P=.002). CONCLUSION: Partnering with patients' family members to provide fundamental care to the patients significantly improved the respect, collaboration, support, and overall scores on the family-centered care survey at 48 hours.

Positive Effects of a Nursing Intervention on Family-Centered Care in Adult Critical Care

OBJECTIVE: In a cardiothoracic and vascular intensive care unit, to compare nasal high-flow (NHF) oxygen therapy and standard high-flow face mask (HFFM) oxygen therapy in patients with mild to moderate hypoxemic respiratory failure. METHODS: In a prospective randomized comparative study, 60 patients with mild to moderate hypoxemic respiratory failure were randomized to receive NHF or HFFM. We analyzed the success of allocated therapy, noninvasive ventilation rate, and oxygenation. RESULTS: Significantly more NHF patients succeeded with their allocated therapy (P = .006). The rate of noninvasive ventilation in the NHF group was 3/29 (10%), compared with 8/27 (30%) in the HFFM group (P = .10). The NHF patients also had significantly fewer desaturations (P = .009). CONCLUSIONS: NHF oxygen therapy may be more effective than HFFM in treating mild to moderate hypoxemic respiratory failure.

http://rc.rcjournal.com/content/respcare/56/3/265.full.pdf

A Preliminary Randomized Controlled Trial to Assess Effectiveness of Nasal High-Flow Oxygen in Intensive Care Patients

First year nursing students use of social media within education: Results of a survey.

Several authors have highlighted the short- and long-term psychological effects of an intensive care unit (ICU) stay. Few authors have discussed the nurses' perceptions of psychological care. In this research, 12 nurses, who currently work in ICU, were interviewed using a semi-structured technique. Six categories were developed about issues in psychological care. Implications for practice included the important role of the family, need for improved communication and improved staff awareness of issues.

Intensive care nurses' experiences of assessing and dealing with patients' psychological needs.

Background
Critical care practice is a mixture of caring and technological activities. There is debate about whether the balance between these two elements is correct and a concern that critical care units can dehumanise the patient. This research wanted to examine aspects that might affect this balance between the caring and technology within the critical care setting.
Aim
What aspects affect registered health care professionals’ ability to care for patients within the technological environment of a critical care unit?
Methodology
A qualitative approach using ethnography was utilised as this methodology focuses on the cultural elements within a situation. Data collection involved participant observation, document review and semi-structured interviews to triangulate methods as this aids rigour for this approach. A purposeful sample to examine registered health care professionals currently working within the study area was used. A total of 19 participants took part in the study; 8 nurses were observed and 16 health care professionals were interviewed, including nurses, a doctor and 2 physiotherapists. The study took place on a District General Hospital intensive care unit and ethical approval was gained.
Findings
An overarching theme of the ‘Crafting process’ was developed with sub themes of ‘vigilance’, ‘focus of attention, ‘being present’ and ‘expectations’ with the ultimate goal of achieving the best interests for the individual patient.
Conclusion
The areas reflected in this study coincide with the care, compassion, competency, commitment, communication and courage ideas detailed by the Department of Health (2012). Thus, further research to detail more specifically how these areas are measured within critical care may be useful.
Relevance to practice
Caring is a complex concept that is difficult to outline but this article can inform practitioners about the aspects that help and hinder caring in the technical setting to inform training.

Caring and technology in an intensive care unit: an ethnographic study

https://rgu-repository.worktribe.com/preview/298440/PATTERSON%202016%20The%20significance%20of%20personal%20learning%20environments.pdf

The significance of personal learning environments (PLEs) in nursing education: Extending current conceptualizations

Background: Vapotherm 2000i® is a non-invasive high-flow respiratory support system used mainly in the treatment of type 1 respiratory failure. It uses a mixture of oxygen and air to deliver a set concentration via nasal cannula (or tracheostomy mask). The advantage of this system is the high humidity achieved using the integral heated water system. The system has been used in neonatal practice as a replacement for conventional continuous positive airway pressure (CPAP) but there is little published research within the adult setting about its use.

Aim:  This study discusses the indications for the use of this non-invasive high-flow respiratory support system, the system set up, the benefits and complications of the system.

Audit design:  An audit of 72 patients was undertaken within the Surgical High Dependency Unit that collected data on the types of patient receiving the therapy, its effectiveness and patient experience.

Audit findings:  The audit demonstrated reduced respiratory rate and improvement in oxygenation for treated patients.

Conclusion:  A non-invasive high-flow respiratory support system can be effective at improving oxygenation in hypoxic patients. Patients were generally satisfied with the system and the system seems suitable for use in an adult surgical high dependency setting.

Ann M. Price

Papers

First year nursing students use of social media within education: Results of a survey.

Intensive care nurses' experiences of assessing and dealing with patients' psychological needs.

Caring and technology in an intensive care unit: an ethnographic study

The significance of personal learning environments (PLEs) in nursing education: Extending current conceptualizations

Using a high‐flow respiratory system (Vapotherm®) within a high dependency setting