Principle: Choose the mode matched to patient's respiratory drive, lung mechanics, and clinical goal. No mode is universally superior — understand the physiology of each.
VC — Volume Control
Volume-Controlled Ventilation (VCV / CMV)
- Fixed: Tidal volume (TV) delivered every breath
- Variable: Airway pressure changes with compliance/resistance
- Guaranteed minute ventilation
- Risk: high pressures if compliance worsens suddenly (e.g. pneumothorax)
- Monitor peak & plateau pressure closely
- Best for: controlled, sedated patients; ensuring TV in ARDS
PC — Pressure Control
Pressure-Controlled Ventilation (PCV)
- Fixed: Inspiratory pressure delivered each breath
- Variable: Tidal volume depends on compliance
- Pressure-limited — safer for barotrauma risk
- Risk: TV drops if lung compliance worsens → hypoventilation
- Requires careful TV monitoring
- Best for: patients with poor compliance, air-leak syndromes
SIMV
Synchronized Intermittent Mandatory Ventilation
- Delivers set number of mandatory breaths synchronised to patient effort
- Patient may take additional spontaneous breaths between mandatory breaths
- Often combined with Pressure Support for spontaneous breaths
- Historically used for weaning (evidence now favours T-piece or PSV trials)
- Can increase WOB if rate set too low without PS
PRVC / ASV
Pressure-Regulated Volume Control / Adaptive Support Ventilation
- Dual-control mode: targets a set TV but delivers variable pressure
- Automatically adjusts pressure breath-to-breath to achieve target TV
- Protective: won't exceed alarm pressure limit
- ASV additionally adapts RR to minimise WOB (Hamilton ventilators)
- Useful: fluctuating compliance; variable respiratory drive
- Risk: if patient pulls large TVs → pressure drops → lung over-distension still possible
PSV — Pressure Support
Pressure Support Ventilation
- Patient-triggered, spontaneous mode
- Each breath triggered by patient → clinician-set inspiratory pressure applied
- Patient controls RR, inspiratory time, TV
- No mandatory backup rate (requires adequate respiratory drive)
- Most comfortable synchronous mode; reduces WOB
- Used for weaning: gradually reduce PS level
- Apnoea backup alarm essential
CPAP
Continuous Positive Airway Pressure
- Continuous elevated baseline airway pressure throughout respiratory cycle
- No ventilatory support — patient breathes entirely spontaneously
- Maintains alveolar recruitment, reduces atelectasis
- Used: pre-extubation readiness assessment, obstructive sleep apnoea
- On ventilator: CPAP = PEEP level with zero PS
- Requires intact, strong respiratory drive
HFOV — High-Frequency Oscillatory Ventilation
For severe ARDS (PaO2/FiO2 <100) refractory to conventional ventilation
- Very small TVs (1-3 mL/kg) at very high frequencies (3-15 Hz)
- Mean airway pressure maintained at high level (keeps lung open)
- CO2 elimination via oscillation amplitude (ΔP) — not bulk flow
- Parameters: Mean airway pressure (mPaw), frequency (Hz), amplitude (ΔP), FiO2, bias flow
- Specialist training required; available in major GCC tertiary ICUs
- OSCAR/OSCILLATE trials: no mortality benefit over conventional LPV — use selectively
- Consider as rescue before ECMO
| Parameter | Normal Range | ARDS Target | Obstructive (COPD/Asthma) | Nursing Note |
|---|
| Tidal Volume (TV) | 6–8 mL/kg IBW | 4–6 mL/kg IBW | 6–8 mL/kg IBW | Calculate from IBW, not actual weight |
| PEEP | 5 cmH₂O | 8–15 cmH₂O (high PEEP) | 3–5 cmH₂O (auto-PEEP risk) | Titrate to oxygenation/ARDSnet table |
| FiO₂ | 0.21–0.40 | 0.40–1.0 (wean rapidly) | 0.24–0.35 (target SpO₂ 88–92%) | Wean FiO₂ first before decreasing PEEP |
| RR | 12–16 /min | 16–35 /min (allow hypercapnia) | 10–14 /min (allow auto-PEEP measurement) | Monitor for breath stacking |
| I:E Ratio | 1:2 | 1:1 to 1:1.5 | 1:3 to 1:4 (prolonged expiration) | Inverse ratio ventilation in ARDS (monitor haemodynamics) |
| Peak Flow | 40–60 L/min | 40–60 L/min | 60–80 L/min | High flow in obstructive to shorten Ti |
| Trigger Sensitivity | −1 to −2 cmH₂O (pressure) / 2 L/min (flow) | Same | Flow triggering preferred (less auto-PEEP impact) | Too sensitive → auto-triggering; too high → increased WOB |
| Plateau Pressure | <30 cmH₂O | <30 cmH₂O (strict) | <30 cmH₂O | Assess at end-inspiratory pause; reflects alveolar pressure |
Clinical Pearl: Always use Ideal Body Weight (IBW) for TV calculations — never actual weight. An obese patient with IBW 60 kg gets TV 360–480 mL, NOT based on their actual 120 kg.
📊Pressure Waveform Concepts
Plateau Pressure
<30 cmH₂O
Driving Pressure
<15 cmH₂O
Mean Airway Pressure
Oxygenation driver
Auto-PEEP
Expiratory pause measure
Driving Pressure = Plateau Pressure − PEEP. Strong predictor of ARDS mortality. Target <15 cmH₂O. Reduce TV or increase PEEP to lower driving pressure.
Criteria (all required): Acute onset within 1 week of known insult | Bilateral opacities on CXR/CT not fully explained by effusions/lobar collapse | Not fully explained by cardiac failure or fluid overload | Impaired oxygenation by P/F ratio
Mild ARDS
200–300
PaO₂/FiO₂ (mmHg)
with PEEP/CPAP ≥5 cmH₂O
Moderate ARDS
100–200
PaO₂/FiO₂ (mmHg)
with PEEP ≥5 cmH₂O
Severe ARDS
<100
PaO₂/FiO₂ (mmHg)
with PEEP ≥5 cmH₂O
IBW Calculation
Male: IBW = 50 + 0.91 × (height cm − 152.4)
Female: IBW = 45.5 + 0.91 × (height cm − 152.4)
Use the IBW calculator in the tab below. Always base TV on IBW regardless of actual body weight.
Tidal Volume Targets
- ✓Start: 6 mL/kg IBW (may start at 8 mL/kg and reduce)
- ✓Target: 6 mL/kg IBW in ARDS
- ✓Reduce to 4 mL/kg IBW if plateau pressure >30 cmH₂O
- ✗Never exceed 8 mL/kg IBW in ARDS
- ✗Do not normalise PaCO₂ at expense of high TVs
ARDSnet PEEP / FiO₂ Table
| Lower PEEP Strategy | Higher PEEP Strategy (Severe ARDS) |
|---|
| FiO₂ | PEEP (cmH₂O) | FiO₂ | PEEP (cmH₂O) |
|---|
| 0.30 | 5 | 0.30 | 5 |
| 0.40 | 5–8 | 0.30 | 8–10 |
| 0.50 | 8–10 | 0.30 | 10–12 |
| 0.60 | 10 | 0.40 | 12–14 |
| 0.70 | 10–12 | 0.40 | 14–16 |
| 0.80 | 12–14 | 0.50 | 16–18 |
| 0.90 | 14–16 | 0.50–0.80 | 18–20 |
| 1.0 | 18–24 | 0.80–1.0 | 20–24 |
Target: SpO₂ 88–95% / PaO₂ 55–80 mmHg. Wean FiO₂ before lowering PEEP.
Permissive Hypercapnia
- ✓Accept rising PaCO₂ to maintain lung-protective TVs
- ✓Target pH ≥ 7.20 is tolerated
- ✓If pH <7.20: increase RR (max 35/min), consider NaHCO₃
- ✗Avoid in raised ICP, severe pulmonary hypertension, right heart failure
Driving Pressure (ΔP)
ΔP = Plateau Pressure − PEEP
- ✓Target <15 cmH₂O (strongest independent predictor of mortality)
- ✓To reduce ΔP: lower TV or increase PEEP
- ✗High ΔP with low TV = low compliance → poor prognosis
Recruitment Manoeuvres
Controversy: ART Trial showed harm with aggressive RM + PEEP titration. Current practice: selective use only.
- Sustained inflation: 40 cmH₂O for 40 seconds
- Staircase RM: incremental PEEP increases
- Assess response with P/F ratio and compliance
- Contraindications: haemodynamic instability, pneumothorax
Adjunct ARDS Therapies
- ✓Prone positioning ≥16h/day — mortality benefit (PROSEVA trial) in PF <150
- ✓Neuromuscular blockade (cisatracurium 48h) — reduces dyssynchrony; benefit debated
- ✓Conservative fluid — after resuscitation phase
- ✓ECMO — PaO₂/FiO₂ <80 refractory: refer to ECMO centre (King Fahad, Cleveland Clinic Abu Dhabi)
- ✗Routine inhaled NO, surfactant — no mortality benefit
HME Filter (Heat-Moisture Exchanger)
- ✓Change every 5–7 days (or per manufacturer)
- ✓Change immediately if visibly soiled or secretion-laden
- ✗Do NOT use HME if secretions are thick, copious, or bloody — use heated humidifier instead
- ✗Do NOT use HME with heated humidifier simultaneously
Heated Humidifier
- ✓Check water level every 4 hours — never run dry
- ✓Target temperature 37°C at Y-piece
- ✓Empty condensation from circuit (drain away from patient)
- ✓Use sterile water only
- ✗Circuit change: only if visibly soiled (not routine daily change — increases VAP risk)
Cuff Pressure Management
Target cuff pressure: 20–25 cmH₂O
- Check cuff pressure every 4–8 hours with cuff manometer
- Check immediately after repositioning, transport, or post-intubation
- Document cuff pressure each check
- If cuff pressure >30 cmH₂O → ischaemic tracheal injury risk — deflate slowly
- If cuff pressure <20 cmH₂O → microaspiration risk — inflate gently
Subglottic suction: Use ETT with subglottic suction port — continuous aspiration −20 cmH₂O. Reduces VAP incidence by 50%.
ETT Tube Security & Position
- Document ETT position in cm at corner of mouth / lip
- Normal adult position: 21–23 cm (female) / 23–25 cm (male) at lips
- Confirm on CXR: tip 3–5 cm above carina (at level of aortic knuckle)
- Retape / reposition every 24 hours and PRN
- Alternate sides of mouth daily to prevent pressure injury
- Check cm marking after repositioning, transport, or procedures
- Two-nurse technique for all repositioning to prevent displacement
VAP (Ventilator-Associated Pneumonia) is a key CBAHI/JCIA quality metric. GCC hospitals report rates of 2–15 per 1000 ventilator days. Target: <2/1000 ventilator days.
Head of Bed Elevation
Maintain 30–45° at all times unless contraindicated (spinal precautions). Document HOB angle every 4h.
Oral Care
Chlorhexidine 0.2% oral rinse every 2–4 hours. Toothbrushing twice daily. Suction oral cavity before oral care.
Subglottic Suction
Continuous aspiration above cuff. Reduces VAP by up to 50% in patients ventilated >48h.
Daily SAT + SBT
Daily Spontaneous Awakening Trial (sedation hold) + Spontaneous Breathing Trial. Reduces ventilator days and VAP incidence.
Cuff Pressure Maintenance
Maintain 20–25 cmH₂O. Prevents aspiration around cuff. Document q4–8h.
Hand Hygiene
WHO 5 moments strictly before and after all ETT/circuit interactions. Gloves + ABHR compliance audited by infection control.
| Letter | Component | Nursing Action |
|---|
| A | Assess, Prevent & Manage Pain | CPOT / NRS scale q4h; adequate analgesia before care procedures |
| B | Both SAT & SBT Daily | Coordinate sedation hold + SBT daily; document outcomes |
| C | Choice of Analgesia-First Sedation | RASS target −1 to 0; avoid deep sedation; use RASS/SAS q2h |
| D | Delirium Assessment & Management | CAM-ICU q8h; early mobility; avoid benzodiazepines; orientation measures |
| E | Early Exercise & Mobility | Passive ROM → active exercises → chair sitting → ambulation with ventilator |
| F | Family Engagement & Empowerment | Open visiting; family education; Arabic communication; involve in care decisions |
Closed-Circuit Suction (CCS)
- Pre-oxygenate with FiO₂ 1.0 for 30–60 seconds
- Insert suction catheter to carina resistance then withdraw 1 cm
- Apply suction only during withdrawal (−80 to −120 mmHg)
- Each suction pass ≤15 seconds
- Reconnect circuit, return to prior FiO₂ settings
- Document: colour, consistency, amount of secretions
Suction Indications
- ✓Visible secretions in ETT
- ✓High pressure alarm with secretions suspected
- ✓Audible secretions / coarse breath sounds
- ✓Declining SpO₂ from secretion burden
- ✗Routine timed suction without clinical indication — increases trauma risk
- ✗Normal saline instillation — no evidence, contraindicated
Assess weaning readiness daily. Prolonged unnecessary ventilation increases ICU complications. The goal is earliest safe extubation.
Clinical Readiness Criteria
- ✓Cause of respiratory failure improving or reversed
- ✓FiO₂ ≤ 0.40–0.50 with adequate oxygenation (SpO₂ ≥92%)
- ✓PEEP ≤ 5–8 cmH₂O
- ✓Haemodynamically stable (no vasopressors or low dose)
- ✓Adequate respiratory drive (triggers ventilator spontaneously)
- ✓Protective airway reflexes present (cough, gag)
- ✓Able to follow simple commands (if sedation allows)
- ✓Adequate secretion management
- ✗Active haemodynamic instability
- ✗Worsening oxygenation or underlying process
RSBI — Rapid Shallow Breathing Index
RSBI = RR (breaths/min) ÷ TV (litres)
| RSBI Value | Interpretation |
|---|
| <80 | High likelihood of weaning success |
| 80–105 | Moderate likelihood — proceed with SBT |
| 105–120 | Borderline — clinical context important |
| >120 | High likelihood of weaning failure |
Measure during T-piece trial or minimal PS (0–5 cmH₂O) for 1–2 minutes. RSBI <105 is the classic threshold for proceeding to extubation trial.
SBT Methods
T-Piece Trial
Disconnect from ventilator to T-piece. Humidified O₂ supplied. Patient breathes completely spontaneously. Duration 30–120 minutes. Gold standard but requires close monitoring.
Low Pressure Support (PSV 5–8 cmH₂O)
Minimal PS overcomes ETT resistance. Patient remains on ventilator for close monitoring. PEEP 5 cmH₂O. Duration 30–120 minutes. Preferred in most ICUs for safety monitoring.
SBT Failure Criteria (Stop immediately)
- ✗RR > 35 breaths/min sustained
- ✗SpO₂ < 90% (or PaO₂ <60 mmHg)
- ✗HR >140 /min or change >20% from baseline
- ✗SBP >180 or <90 mmHg
- ✗Increasing work of breathing (accessory muscle use, paradox)
- ✗Agitation, diaphoresis, anxiety
- ✗Altered consciousness
On failure: return to previous ventilator settings, investigate cause, reassess in 24h minimum.
Extubation Decision
- Confirm cuff-leak test positive (leak >10–12% of TV suggests no significant subglottic oedema)
- Discontinue sedation — patient awake, following commands
- Suction oropharynx and ETT thoroughly
- Pre-oxygenate FiO₂ 1.0
- Deflate cuff fully; remove ETT on expiration or deep inspiration
- Apply face mask oxygen immediately; assess phonation and breathing
- Remain at bedside 30 minutes post-extubation
Post-Extubation High-Risk Patients
High-risk for post-extubation respiratory failure: ICU stay >7 days, heart failure, obesity, COPD, APACHE II >12, weak cough, hypersecretions
| Intervention | Indication |
|---|
| HFNC (High-Flow Nasal Cannula) | Preferred post-extubation in high-risk; reduces reintubation rate |
| NIV / BiPAP | Post-extubation respiratory failure; COPD exacerbation; cardiogenic pulmonary oedema |
| Reintubation | Failure of NIV/HFNC; deteriorating — do not delay |
Tracheostomy Decannulation
Decannulation criteria differ from extubation. Patients need: adequate swallow, adequate cough, minimal secretions, no need for PEEP.
- Downsizing tracheostomy tube before decannulation
- Capping trials: cap tube and observe 24–48h
- Swallowing assessment by speech therapy
- Methylene blue test for aspiration if indicated
- Stoma care post-decannulation (Vaseline gauze dressing)
- Stoma typically closes within 5–7 days
- Refer for home ventilation if prolonged dependence (PMV)
- GCC home ventilation services expanding (Saudi, UAE)
NEVER silence a ventilator alarm without identifying and correcting the cause. Assess the patient first — then the ventilator.
HIGH PRESSURE Alarm
Pressure exceeds set high-pressure limit
Causes:
- Secretions / mucus plug in airway
- Patient biting on ETT
- Kinked or occluded circuit
- Bronchospasm (wheeze on auscultation)
- Pneumothorax (absent breath sounds unilaterally)
- Right mainstem intubation (ETT too deep)
- Decreased lung compliance (worsening ARDS)
- Coughing / breath-stacking
Actions:
- Assess patient — inspect ventilator circuit visually
- Suction airway if secretions suspected
- Check ETT cm marking and depth
- Insert bite block if biting
- Auscultate — absent breath sounds → emergency CXR + call doctor
- Check ABG if cause unclear
LOW PRESSURE / LOW VOLUME Alarm
Pressure or exhaled TV below set minimum
Causes:
- Circuit disconnection (most common)
- Cuff leak / deflation
- ETT dislodgement (accidental extubation)
- Large leak around tracheostomy
- Patient removed HME or connector
Actions:
- Immediately check all circuit connections (patient → ventilator)
- Confirm ETT still in position — check cm marking at lips
- Check cuff pressure — inflate if low
- If accidental extubation: manual bag-valve-mask + urgent reintubation
- Listen for audible air leak around neck / mouth
APNOEA Alarm
No detected breath within apnoea interval (typically 20s)
Causes:
- Patient apnoea (CNS depression, over-sedation)
- Trigger sensitivity too low (patient effort not detected)
- Circuit disconnect (concurrent low-pressure alarm)
- Auto-PEEP exceeding trigger threshold
Actions:
- Assess patient responsiveness immediately
- Check for chest rise, breathing effort
- Reduce sedation if over-sedated
- Adjust trigger sensitivity if no effort detected
- Switch to controlled mode if apnoeic
- Measure auto-PEEP if obstructive
LOW FiO₂ / LOW O₂ Alarm
Delivered FiO₂ below set minimum
Causes:
- Oxygen wall source failure / disconnection
- O₂ cylinder empty (transport)
- Blender malfunction
- Air/O₂ supply reversal
Actions:
- Check O₂ supply connection at wall
- Check O₂ flow meter and pipeline pressure
- Switch to backup O₂ cylinder immediately
- Call hospital engineering if wall failure
- If FiO₂ cannot be assured: manual ventilation with 100% O₂ bag
D
Displacement
ETT displaced — accidental extubation, right mainstem intubation, oesophageal intubation. Check cm marking, auscultate bilaterally, check CO₂ waveform.
O
Obstruction
Secretions, mucus plug, biting, kinked tube. Suction, insert bite block, check for kinks throughout circuit.
P
Pneumothorax
Tension pneumothorax is immediately life-threatening. Absent unilateral breath sounds + haemodynamic collapse. Needle decompression before CXR if suspected tension.
E
Equipment
Ventilator malfunction, disconnection, power failure. If any doubt about ventilator → disconnect, manual bag-ventilate, call for immediate ventilator replacement.
S
Stacking / PEEP
Auto-PEEP / breath stacking — obstructive disease. Disconnect briefly for passive expiration. Reduce RR, increase expiratory time, use expiratory pause to measure auto-PEEP.
If ventilator is suspected to malfunction and patient is deteriorating — do not troubleshoot. Act immediately.
- Disconnect patient from ventilator
- Manually ventilate with self-inflating bag-valve-mask (100% O₂)
- Call for immediate ventilator replacement and escalate to senior nurse/doctor
- Maintain manual ventilation until new ventilator ready and confirmed functional
- Document incident; report per facility biomedical/incident reporting policy
Preparation: Manual resuscitation bag and mask must be present at every ventilated patient's bedside at all times — check at start of every shift.
Saudi Arabia
- Among highest ICU bed ratios globally: >8 ICU beds / 100,000 population
- CBAHI (Saudi) and JCIA accreditation requirements include VAP bundle compliance metrics
- King Fahad Medical City, KFSH&RC: ECMO programs
- Saudi Critical Care Society (SCCM-affiliated) guidelines
UAE & Gulf States
- Cleveland Clinic Abu Dhabi: ECMO, advanced ARDS management
- Dubai Health Authority (DHA), DOH: accreditation standards with ventilation protocols
- Significant nursing workforce from Philippines, India, UK, other nationalities
- Arabic-language family communication mandatory skill
Workforce Context
- Multicultural nursing teams — standardised protocols essential
- Ventilator training programmes mandatory for ICU nurses
- Simulation-based ventilator training increasingly used in GCC
- Critical Care Nursing Certification encouraged (CCRN, CCRN-K)
MERS-CoV ARDS
- Saudi Arabia: largest MERS-CoV outbreak globally (2012–ongoing)
- Severe ARDS with high mortality (30–40% in ICU cases)
- ARDSnet LPV, prone positioning, HFOV used
- Full PPE for aerosol-generating procedures (intubation, suction)
- Dromedary camel exposure history: relevant epidemiological context
- Strict contact/droplet/airborne precautions in ICU
COVID-19 Pandemic
- GCC hospitals experienced significant ICU surge 2020–2022
- Broad ARDSnet protocol implementation across all GCC states
- Prone positioning widely adopted — nursing training scaled rapidly
- Extended ventilator use (prolonged dependence >14 days common)
- Accelerated tracheostomy programmes to free ICU capacity
- Rapid HFNC and NIV scale-up to prevent intubation
Ramadan & Ventilated Patients
- Ventilated patients are medically exempt from fasting (Islamic scholarly consensus)
- Families may request Quran recitation played near bedside — culturally important and should be facilitated
- Prayer times: families may gather at prayer times — facilitate visiting accordingly
- Chaplaincy / Imam services: available in major GCC hospitals; engage proactively
- Enteral nutrition timing: no adjustment needed for ventilated patients; families may still ask
- Muslim dietary products: halal-certified enteral feeds are standard in GCC ICUs
Arabic Family Communication
- Use certified medical interpreters for formal discussions — not family members as interpreters for clinical decisions
- Common phrases: "Your family member is on a breathing machine that breathes for them"
- Family is central decision-making unit in GCC — engage entire family council, not just one person
- Male family head (father, eldest son) traditionally consulted first in Saudi/conservative families — remain flexible and patient-centred
- Written materials in Arabic for common ventilation explanations improve comprehension
Ventilator withdrawal in GCC is a complex ethical, cultural, and religious issue. Nurses play a central role in family support and comfort care regardless of decision.
Islamic Ethical Framework
- Death is God's will (tawakkul) — causing premature death forbidden
- Withholding vs. withdrawing treatment: distinction is debated among Islamic scholars
- Many families equate ventilator withdrawal with causing death — extensive counselling required
- Islamic Medical Association guidelines advise futility discussions with family and Islamic ethics committee
- Palliative care approach developing in GCC but historically under-utilised
Nursing Role in EOL Care
- Provide excellent comfort care regardless of decisions made
- Facilitate family presence, prayer, religious support
- Document family meetings, decisions, and care plans accurately
- Support team decisions — escalate concerns through proper channels
- Manage dyspnoea: opioid infusions for comfort — communicate purpose to family
- Refer to hospital ethics committee if family-team conflict
| Metric | Target | GCC Benchmark | Nursing Accountability |
|---|
| VAP Rate | <2 per 1000 ventilator days | Varies: 2–15 across GCC hospitals | VAP bundle compliance audit |
| HOB ≥30° compliance | >95% | Reported in CBAHI surveys | Document angle every 4h |
| Oral care compliance | >95% | Core nursing bundle metric | Chlorhexidine q2-4h documentation |
| Cuff pressure check | q4-8h documented | Core CBAHI standard | Cuff manometer use and documentation |
| Daily SAT/SBT | >90% of eligible patients | ABCDEF bundle metric | Coordinate with medical team |
| Ventilator days | Minimise — shortest safe duration | Weaning protocol adherence | Daily weaning readiness assessment |
GCC home ventilation services are expanding, particularly in Saudi Arabia and UAE, to manage patients with prolonged ventilator dependence (PMV — Prolonged Mechanical Ventilation defined as >21 days).
- Discharge to home or long-term care facility with tracheostomy ventilation
- Family training: circuit changes, suctioning, tracheostomy care, emergency protocols
- Remote monitoring programs in development in Saudi Arabia
- Neuromuscular diseases (ALS, SMA, muscular dystrophy) — primary home vent population
- Home care nursing: ventilator-trained nurses increasingly in demand in GCC
- HFNC at home: available in select GCC home-care programs for post-COVID fibrosis