Airborne spread of SARS-CoV-2 while using high-flow nasal cannula oxygen therapy: myth or reality?

Haymet, Andrew B.; Bassi, Gianluigi Li; Fraser, John F.

doi:10.1007/s00134-020-06314-w

Cited by 25 publications

(30 citation statements)

References 12 publications

(11 reference statements)

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“…However, the mortality risk was similar across groups, our results were robust across sensitivity analysis adjusting for imbalanced covariates, and the intubation risk in the conservative group was 38%, which is in line with previous reports [ 27 ]. Finally, this study cannot offer any information regarding a potential increased risk of COVID-19 infection in healthcare professionals with HFNO use although studies have not been able to show an increase risk with this therapy [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Artigas¹,

et al. 2021

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Purpose Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. Methods We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. Results Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: − 8.2 days; 95% CI − 12.7 to − 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). Conclusions The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

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Section: Discussionmentioning

confidence: 99%

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Artigas¹,

et al. 2021

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“…Simulation studies on aerosol production during tracheal intubation and extubation have provided divergent results [ 65 , 66 ]. There is conflicting evidence on aerosol generation with NIV or HFNO [ 35 , 67 , 68 ]. The experts have taken a conservative approach, labelling procedures as aerosol generating, until robust evidence is generated to the contrary.…”

Section: Expert Clinical Practice Statementsmentioning

confidence: 99%

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method

et al. 2021

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Background Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). Results Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16–24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. Conclusion Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. Trial registration: The study was registered with Clinical trials.gov Identifier: NCT04534569.

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“…Finally, this study cannot offer any information regarding a potential increased risk of COVID-19 infection in healthcare professionals with HFNO use although studies have not been able to show an increase risk with this therapy. 45…”

Section: Discussionmentioning

confidence: 99%

High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure

Artigas

Ferreyro

Angriman

et al. 2021

Preprint

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Purpose: Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19.Methods: We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding.Results: Out of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days), and a reduction in ICU length of stay (mean difference: -8.2 days; 95% CI -12.7 to -3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64).Conclusions: The use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

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Airborne spread of SARS-CoV-2 while using high-flow nasal cannula oxygen therapy: myth or reality?

Cited by 25 publications

References 12 publications

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method

High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure

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