Implementation of High-Flow Oxygen Therapy in a Surgical High-Dependency Unit: A Cohort Study

Area of Science:

• Respiratory Care
• Critical Care Medicine
• Health Services Research

Background:

• High-flow oxygen therapy (HFOT) is a non-invasive respiratory support method traditionally used in intensive care units (ICUs).
• Its benefits include improved oxygenation and reduced work of breathing, prompting its use in diverse medical settings.
• This study evaluated HFOT implementation in a surgical high-dependency unit (SHDU) to optimize patient care and ICU resource utilization.

Purpose of the Study:

• To assess the feasibility and safety of implementing HFOT outside the ICU in SHDUs.
• To evaluate patient outcomes associated with HFOT use in this setting.
• To determine the effectiveness of a structured training protocol for healthcare providers on HFOT.

Main Methods:

• A cohort study involving 96 HFOT administrations in SHDUs at Singapore General Hospital.
• Development and implementation of a standardized HFOT protocol for patient selection, initiation, and management.
• Comprehensive staff training program including face-to-face sessions, online education, and ongoing support.

Main Results:

• 66.7% of patients (64/81) were successfully weaned to conventional oxygen therapy without ICU escalation.
• 25% of patients (24/81) required ICU-level ventilatory support.
• Implementation faced challenges including COVID-19 disruptions, limited experience, and logistical issues, which were mitigated by training and support.

Conclusions:

• HFOT is a feasible and effective alternative to ICU care for selected patients in SHDUs.
• Successful implementation relies on structured protocols, comprehensive staff education, and adequate resource allocation.
• This approach can optimize patient management and ICU resource utilization.