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Original Article

Development of Nursing Practice Guidelines for Non-humidified Low Flow Oxygen Therapy by Nasal Cannula

Ae-Ri-Na Nam1, Woo-Hyun Bae1, Mi-Mi Park1, Eun-Jeong Ko1, Byung-Nam Park1, Jeong-Ok Park1, Ji-Yeoung Yim1
Journal of Korean Academy of Nursing Administration 2013;19(1):87-94.
Published online: January 31, 2013

1Ajou Medical Center, Korea.

Correspondence: Park, Mi-Mi. Ajou Medical Center, San 5, Woncheon-Dong, Yeongtong-Gu, Suwon 443-749, Korea. Tel: 82-31-219-5525, Fax: 82-31-219-5520, withmimi@ajou.ac.kr
• Received: November 14, 2012   • Revised: January 8, 2013   • Accepted: January 13, 2013

Copyright © 2013 Korean Academy of Nursing Administration

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  • Purpose
    The purpose of this study was to provide a basis for non-humidified low flow oxygen by nasal cannula and to provide a guide for consistent care in nursing practice.
  • Methods
    A methodological study on the development of guidelines with experts' opinions on collected items, framing PICO questions, evaluating and synthesizing texts which were searched with the key words (low flow oxygen, nasal cannula, humidification of oxygen, guideline) from web search engines.
  • Results
    Of the 45 researched texts on the web, 9 texts relevant to the theme were synthesized and evaluated. All patients with humidified or non-humidified oxygen therapy reported that they had no discomfort.
  • Conclusion
    The results indicate that there are no tangible grounds for patients' perceived differences between the humidified and non-humidified oxygen under 4L/min supplied by nasal cannula. with oxygen. Therefore, non-humidification oxygen therapy is strongly advised when suppling under 4L/min oxygen by nasal cannula (recommended grade A).
  • Key Words: Oxygen therapy; Low flow oxygen; Non-humidified; Evidence based clinical practice guideline; Nursing practice guideline
  • 1. Andre D, Thurston N, Brant R, Flemons W, Fofonoff D, Ruttimann A, et al. Randomized double-blind trial of the effects of humidified compared with nonhumidified low flow oxygen therapy on the symptoms of patients. Can Respir J. 1997;4(2):76-80.
  • 2. Brown CE, Wickline MA, Ecoff L, Glaser D. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. J Adv Nurs. 2009;65:371-381. http://dx.doi.org/10.1111/j.1365-2648.2008.04878.x
  • 3. Campbell EJ, Baker MD, Crites-Silver P. Subjective effects of humidification of oxygen for delivery by nasal cannula. A prospective study. Chest. 1988;93:289-293. http://dx.doi.org/10.1378/chest.93.2.289
  • 4. Dearholt SL, Dang D. Johns Hopkins nursing: Evidence-based practice: Model and guidelines. 2012;2nd ed. Indianapolis, IN, Sigma Theta Tau International.
  • 5. Déry R, Pelletier JJ, Acques A, Clavet M, Haude JJ. Humidity in anesthesiology III. Heat and moisture patterns in the respiratory tract during anesthesia with the semi-closed system. Can Anaesth Soc J. 1967;14:287-298. http://dx.doi.org/10.1007/BF03003698
  • 6. Estey W. Subjective effects of dry versus humidified low flow oxygen. Respir Care. 1980;35:1265-1266.
  • 7. Field MJ, Lohr KN. Clinical practice guideline: Directions for a new program. 1990;Washington DC, National Academy Press.
  • 8. Fulmer JD, Snider GL. ACCP-NHLBI national conference on oxygen therapy. Chest. 1984;86:234-247. http://dx.doi.org/10.1378/chest.86.2.234
  • 9. Gu MO, Cho MS, Cho YA, Jeong JS, Jeong IS, Park JS, et al. Topics for evidence-based clinical nursing practice guidelines in Korea. J Korean Clin Nurs Res. 2011;17:307-318.
  • 10. Hess D, Figaszewski E, Henry D, Hoffman S, Pino D. Subjective effects of dry versus humidified low flow oxygen on the upper respiratory tract. Respir Ther. 1982;12:71-75.
  • 11. Jackson C. Humidification in the upper respiratory tract: A physiological overview. Intensive Crit Care Nurs. 1996;12:27-32.
  • 12. Kallstrom TJ. AARC clinical practice guideline: Oxygen therapy for adult in the acute care facility-2002 revision & update. Respir Care. 2002;47:717-720.
  • 13. Kalokerinou-Anagnostopoulou A. Johns Hopkins nursing evidence-based practice model and guidelines: Book review. Hell J Nurs Sci. 2008;1(2):83-85.
  • 14. Leake PY. Teaming with students and a sacred cow contest to make changes in nursing practice. J Contin Educ Nurs. 2004;35(6):271-277.
  • 15. Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & health care. 2005;Philadelphia, Lippincott Williams & Wilkins.
  • 16. Miyamoto K, Nishimura M. Nasal dryness discomfort in individuals receiving dry oxygen via nasal cannula. Respir Care. 2008;53:503-504.
  • 17. O'Driscoll BR, Howard LS, Davison AG. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63:vi1-vi68. http://dx.doi.org/10.1136/thx.2008.102947
  • 18. Park MH. Understanding and application of evidence based nursing. 2006;1st ed. Seoul, Koonja.
  • 19. Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: Overview and practical applications. J Adv Nurs. 2012;Advanced online publication. http://dx.doi.org/10.1111/j.1365-2648.2012.06122.x
Figure 1
The Johns Hopkins Nursing Evidence-Based Practice Model.
jkana-19-87-g001.jpg
Table 1
Appraisal of Individual Evidence and Assessment Risk of Bias
jkana-19-87-i001.jpg

*Quality of individual evidence (used GRADE profiler) A. high: further research is very unlikely to change our confidence in the estimate of effect; B. moderate: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; C. low: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; D. very low: any estimate of fact is very uncertain; †Grading of recommendation (O'Driscoll et al., 2008); ‡RoBANS: Risk of Bias Assessment tool for Non-randomized Study; §RoB: revised Cochrane Risk of Bias.

Table 2
Evidence Level, Quality Guide and Evidence Synthesis of JHNEBP
jkana-19-87-i002.jpg

*Level type

Level I: experimental study, randomized controlled trial (RCT), systemic review of RCTs with or without meta-analysis; Level II: quasi-experimental studies, systematic review of a combination RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis; Level III: non-experimental study, systematic review of a combination of RCTs, quasi-experimental, and non-experimental studies, or non-experimental studies only, with or without meta-analysis, qualitative study of systematic review of qualitative studies with or without meta-synthesis; Level IV: opinion of respected authorities and/or reports of nationally recognised expert committees/consensus panels based on scientific evidence; Level V: evidence obtained from literature reviews, quality improvement, program evaluation, financial evaluation, or case reports, opinion of nationally recognized expert(s) based on experimental evidence

†Dearholt & Dang (2012). p233, Appendix C: Evidence level and quality guide.

Table 3
Levels of Evidence and Grade of Recommendations by the *EORTC
jkana-19-87-i003.jpg

*EORTC=European Organization for Research and Treatment of Cancer

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Humidification of Blow-By Oxygen During Recovery of Postoperative Pediatric Patients: One Unit's Journey
      Suzanne Donahue, Robert M. DiBlasi, Karen Thomas
      Journal of PeriAnesthesia Nursing.2018; 33(6): 964.     CrossRef
    • The nasal oxygen practice in intensive care units in China: A multi-centered survey
      Zunjia Wen, Junyu Chen, Lanzheng Bian, Ailing Xie, Mingqi Peng, Mei Li, Li Wei, Shane Patman
      PLOS ONE.2018; 13(8): e0203332.     CrossRef

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    Development of Nursing Practice Guidelines for Non-humidified Low Flow Oxygen Therapy by Nasal Cannula
    J Korean Acad Nurs Adm. 2013;19(1):87-94.   Published online January 31, 2013
    DOI: https://doi.org/10.11111/jkana.2013.19.1.87
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    • Citation for the content below
    Development of Nursing Practice Guidelines for Non-humidified Low Flow Oxygen Therapy by Nasal Cannula
    J Korean Acad Nurs Adm. 2013;19(1):87-94.   Published online January 31, 2013
    DOI: https://doi.org/10.11111/jkana.2013.19.1.87
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    • 0
    Development of Nursing Practice Guidelines for Non-humidified Low Flow Oxygen Therapy by Nasal Cannula
    Image
    Figure 1 The Johns Hopkins Nursing Evidence-Based Practice Model.

    Figure 1

    Development of Nursing Practice Guidelines for Non-humidified Low Flow Oxygen Therapy by Nasal Cannula

    Appraisal of Individual Evidence and Assessment Risk of Bias

    *Quality of individual evidence (used GRADE profiler) A. high: further research is very unlikely to change our confidence in the estimate of effect; B. moderate: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; C. low: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; D. very low: any estimate of fact is very uncertain; †Grading of recommendation (O'Driscoll et al., 2008); ‡RoBANS: Risk of Bias Assessment tool for Non-randomized Study; §RoB: revised Cochrane Risk of Bias.

    Evidence Level, Quality Guide and Evidence Synthesis of JHNEBP

    *Level type

    Level I: experimental study, randomized controlled trial (RCT), systemic review of RCTs with or without meta-analysis; Level II: quasi-experimental studies, systematic review of a combination RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis; Level III: non-experimental study, systematic review of a combination of RCTs, quasi-experimental, and non-experimental studies, or non-experimental studies only, with or without meta-analysis, qualitative study of systematic review of qualitative studies with or without meta-synthesis; Level IV: opinion of respected authorities and/or reports of nationally recognised expert committees/consensus panels based on scientific evidence; Level V: evidence obtained from literature reviews, quality improvement, program evaluation, financial evaluation, or case reports, opinion of nationally recognized expert(s) based on experimental evidence

    †Dearholt & Dang (2012). p233, Appendix C: Evidence level and quality guide.

    Levels of Evidence and Grade of Recommendations by the *EORTC

    *EORTC=European Organization for Research and Treatment of Cancer
    Table 1 Appraisal of Individual Evidence and Assessment Risk of Bias

    *Quality of individual evidence (used GRADE profiler) A. high: further research is very unlikely to change our confidence in the estimate of effect; B. moderate: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; C. low: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; D. very low: any estimate of fact is very uncertain; †Grading of recommendation (O'Driscoll et al., 2008); ‡RoBANS: Risk of Bias Assessment tool for Non-randomized Study; §RoB: revised Cochrane Risk of Bias.

    Table 2 Evidence Level, Quality Guide and Evidence Synthesis of JHNEBP

    *Level type

    Level I: experimental study, randomized controlled trial (RCT), systemic review of RCTs with or without meta-analysis; Level II: quasi-experimental studies, systematic review of a combination RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis; Level III: non-experimental study, systematic review of a combination of RCTs, quasi-experimental, and non-experimental studies, or non-experimental studies only, with or without meta-analysis, qualitative study of systematic review of qualitative studies with or without meta-synthesis; Level IV: opinion of respected authorities and/or reports of nationally recognised expert committees/consensus panels based on scientific evidence; Level V: evidence obtained from literature reviews, quality improvement, program evaluation, financial evaluation, or case reports, opinion of nationally recognized expert(s) based on experimental evidence

    †Dearholt & Dang (2012). p233, Appendix C: Evidence level and quality guide.

    Table 3 Levels of Evidence and Grade of Recommendations by the *EORTC

    *EORTC=European Organization for Research and Treatment of Cancer

    Table 1

    Table 2

    Table 3

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