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

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Evidence Synthesis

Background:

• High-flow nasal cannula (HFNC) therapy is a common treatment for acute respiratory failure.
• While beneficial, HFNC therapy carries risks such as treatment failure and delayed intubation.
• Understanding these risks is crucial for patient care and research direction.

Purpose of the Study:

• To systematically review and categorize the risks associated with HFNC therapy in acutely ill adult patients.
• To identify the most frequently reported risks in the existing literature.

Main Methods:

• A comprehensive scoping review was conducted following the Joanna Briggs Institute methodology.
• Searches were performed across major databases (PubMed, Embase, CINAHL Complete, medRxiv).
• Data were extracted, analyzed using Python (Jupyter Notebook), and an online repository was created.

Main Results:

• 343 articles were included after screening 2975 initial results.
• COVID-19 was the most studied condition (n=145), with peak publications in 2022 (n=110).
• Identified risks were categorized into 8 groups: deterioration, death, device-related events, delay, disposition, debility, distress, and dysphagia (the '8 D's').

Conclusions:

• Acutely ill patients using HFNC therapy face 8 categories of risks.
• Deterioration and death are the most frequently documented risks.
• Device-related events, delay, disposition, debility, and distress require further investigation.