Heated humidified high-flow oxygen therapy in patients admitted to intensive or intermediate care units – Protocol for a DASAIM clinical practice guideline
Creators: name: Andersen, Birgitte Riis
name: Estrup, Stine
name: Hildebrandt, Thomas
name: Ibsen, Michael
name: Illum, Dorte Golbækdal
name: Jørgensen, Mette Marie Boel
name: Møller, Morten Hylander
name: Schröder, Save
name: Vestergaard, Stine Rom
name: Weinreich, Ulla Møller
name: Wesche, Nicolaj
name: Schjørring, Olav Lilleholt
Publisher: name: Zenodo
Year: 2020
Subjects: Oxygen Inhalation Therapy
Respiratory Insufficiency
Intensive Care Units
Hypoxia
Hypercapnia

description: <strong>Introduction</strong> Use of heated humidified high-flow oxygen therapy (HHHF) is widespread in intensive care units (ICUs) and in intermediate care settings. Nevertheless, despite the widespread use, and the existence of several randomised controlled trials and systematic reviews on HHHF in various critically ill patient populations, no clinical practice guidelines on HHHF in the ICU or intermediate care settings overall exist. This publication represents the protocol for a national Danish clinical practice guideline on HHHF use in patients admitted to intensive or intermediate care units. Conducted under the Danish Society of Anaesthesiology and Intensive Care Medicine (DASAIM) with representation from the Danish Society of Respiratory Medicine (DLS). <strong>Objectives</strong> To produce a Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-based national Danish clinical practice guideline on the use of HHHF in adult patients admitted to ICUs or intermediate care units. The overall clinical question that will be assessed is: Can HHHF improve the clinical outcomes of adult patients treated for respiratory failure in intensive or intermediate care units? <strong>Methods</strong> Ten specific<em> p</em>opulations, interventions, comparators and outcomes (PICO) questions have been formulated. These include two overall populations being adult patients with hypoxaemic respiratory failure and hypercapnic respiratory failure, respectively, admitted to intensive or intermediate care units, as well as seven additional relevant patient subpopulations. The interventions will be HHHF for all PICO questions, and the comparators for most questions will be conventional oxygen treatment in open systems, and NIV or mask CPAP. Eight outcomes were selected by guideline participants and prioritised on the base of individual ratings from the guideline participants and from one representative ICU patient. We will systematically search PubMed, Embase and Cochrane Library for relevant publications. Search results will be screened by at least two guideline group members. We will include parallel-group randomised clinical trials (RCTs) and systematic reviews and meta-analyses of such. Cross-over trials, quasi-randomised trials, and before-and-after trials will be included if data from parallel-group RCTs are insufficient to make conclusions. If evidence from interventional trials is insufficient, observational studies, narrative reviews, case-series and case reports will be evaluated to possibly derive an expert opinion. Rating and grading of the evidence will be conducted according to GRADE methodology, the direction (for/against) and grade strength (strong/weak) will be determined for all PICO questions. <strong>Dissemination</strong> The final guideline, when approved by the committee for ICU treatment in DASAIM, will be sought published in a relevant peer reviewed journal. After publication we will apply for endorsement of the guideline by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).