Guideline for the use of High Flow Nasal Cannula
(HFNC)
(HFNC)
We conducted a multi-centre implementation study
across seven intensive care units in the NICRF
network and evaluated a practice guideline for the
use of high-flow nasal cannula (HFNC) in
critically ill patients with hypoxemia. Using a
mixed-methods approach, we combined analysis of
routine ICU registry data with feedback from
healthcare providers to assess feasibility,
acceptability, and real-world use of the
guideline. We identified eligible patients,
monitored HFNC utilization before and after
implementation, and assessed clinical indicators
such as oxygenation outcomes. Alongside this, we
engaged ICU teams to understand their experiences
with the guideline, including its practicality and
relevance in routine care. The study demonstrated
that the guideline was feasible to implement and
well accepted by clinicians, while also
highlighting areas where additional support is
needed to strengthen uptake and sustained use in
resource-limited settings.
Comparison of clinical characteristics and
outcomes between COVID-19 survivors and
non-survivors: a retrospective observational study
We implemented a multi-centre quality improvement
project across four tertiary hospitals in Nepal to
understand the clinical care pathway for COVID-19
patients from outpatient to intensive care. This
activity involved a retrospective review of
patients who initially presented as non-severe but
rapidly progressed to critical illness, analysing
their clinical characteristics, laboratory
parameters, treatment patterns, and outcomes. In
parallel, we conducted multidisciplinary
stakeholder engagements, including focus group
discussions with clinicians, nurses, and hospital
managers, to explore real-world challenges in
triage, referral, and care delivery, as well as
the role of clinical leadership. We also
documented best practices in patient management
and system-level responses, and identified key
gaps such as delays in referral, resource
limitations, and variation in care practices.
Overall, this activity generated practical,
context-specific evidence to inform early risk
identification, improve coordination across levels
of care, and support the development of
standardized, evidence-based clinical pathways in
low-resource settings.
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Critical care services in Bagmati province of
Nepal: A cross sectional survey
We conducted a cross-sectional survey to map and
assess critical care services across Bagmati
Province, Nepal. This activity involved designing
a structured data collection tool, coordinating
with hospitals, and collecting information from
multiple facilities through face-to-face and
telephone interviews. The team compiled data on
ICU availability, service organization, human
resources, infrastructure, and quality improvement
practices. The activity also included data
cleaning, verification, and consolidation to
generate a comprehensive overview of critical care
capacity and service readiness across the
province.
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