High-flow nasal cannula therapy in pediatric care: A regional practice survey from KSA

To describe current practices related to high-flow nasal cannula (HFNC) therapy among respiratory therapists (RTs) working in pediatric settings across the western region of KSA, specifically in the cities of Almadinah Almunawwarah, Jeddah, and Makkah.

Between January and April 2025, a cross-sectional survey was distributed online to RTs working in pediatric inpatient units in the three cities. The validated questionnaire collected data regarding demographics, hospital characteristics, HFNC initiation practices, adjustment methods, assessment routines, and aerosol delivery practices.

In total, 102 RTs from 10 government hospitals participated in the study, where 51.9% worked in standalone children's hospitals. HFNC was most commonly initiated for pneumonia (79.4%) and bronchiolitis (73.5%). Definitions of HFNC varied where 65% of respondents described it as heated gas delivered at a flow rate equal to or exceeding the patient's inspiratory demand. Initial settings were determined based on patient weight (44.1%), therapist-driven protocols (38.2%), or age (9.8%). When oxygenation was suboptimal, 73.5% of RTs increased the FiO₂ and 26.5% increased the flow. In cases of HFNC failure, 89.2% transitioned patients to noninvasive ventilation (bilevel positive airway pressure/continuous positive airway pressure) and 10.8% opted for intubation. Aerosol therapy was administered via HFNC by 88.2% of respondents and 50% used vibrating mesh nebulizers. During aerosol delivery, 4.90% of RTs reduced HFNC flow and 29.4% temporarily discontinued HFNC.

HFNC is commonly used in pediatric care across the western region of KSA. However, our results emphasize the need to establish national guidelines or protocols for pediatric HFNC therapy to ensure standardized care and efficient resource utilization.