Summary of the best evidence for adult nasal high-flow oxygen therapy nebulization management

Objective To systematically search, assess, and compile the best evidence on the management of nebulization in adult patients on nasal high-flow oxygen therapy, thereby providing a reference for evidence-based nursing practice. Methods This evidence summary was conducted following the Joanna Briggs Institute (JBI) methodology for evidence synthesis and was guided by the ‘6S’ evidence resource model. A systematic search was performed in multiple databases, including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and the China Biomedical Literature Database, for publications up to September 2024. The study selection process was reported in accordance with the PRISMA-ScR guidelines. Three researchers independently performed the literature appraisal, evidence extraction, and grading of recommendations. Results In total, 839 records were retrieved, and 13 articles were finally included, comprising 1 clinical decision, 2 guidelines, 1 team standard, 7 expert consensuses, and 2 evidence summaries. Quality appraisal using AGREE II showed all three guidelines/standards scored above 60% across all domains. Among the seven expert consensuses, most items were rated positively. From the included literature, 26 best evidence statements were extracted and summarized across seven key areas: preparation for nebulization, medication management, selection and setup of nebulization devices, proper usage, monitoring and nursing, management of nebulization in respiratory infectious diseases, and patient education. The evidence levels ranged from Level 1 to Level 5, and the grades of recommendation included both A (strong) and B (weak). Conclusion The research has compiled and consolidated the optimal evidence for managing nebulization in adult patients receiving nasal high-flow oxygen therapy. This summary provides a structured compilation of current best practices, primarily derived from guidelines and expert consensus, which can serve as a practical reference to guide the nebulization process for these patients.