High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission

Abstract

Purpose We conducted two World Health Organizationcommissioned reviews to inform use of high-flow nasal cannula (HFNC) in patients with coronavirus disease (COVID-19). We synthesized the evidence regarding efficacy and safety (review 1), as well as risks of droplet dispersion, aerosol generation, and associated transmission (review 2) of viral products. Source Literature searches were performed in Ovid MEDLINE, Embase, Web of Science, Chinese databases, and medRxiv. Review 1: we synthesized results from randomized-controlled trials (RCTs) comparing HFNC to conventional oxygen therapy (COT) in critically ill patients with acute hypoxemic respiratory failure. Review 2: we narratively summarized findings from studies evaluating droplet dispersion, aerosol generation, or infection transmission associated with HFNC. For both reviews,

High-flow nasal cannula for COVID-19 patients: risk of bio-aerosol dispersion

“…[1] Although we do agree with the authors that high-flow nasal cannula (HFNC) might be an effective treatment for hypoxemic COVID-19 patients, we believe that caution should be taken in considering HFNC in COVID-19 patients as data about droplet dispersion and aerosol generation with HFNC are at least controversial. [2] The authors state that the scientific evidence of generation and dispersion of bio-aerosols via HFNC is similar to standard oxygen therapies. This statement is mainly based on the studies of Hui et al [3] and Ip et al [4] which showed that HFNC led to a smaller dispersion distance compared to non-rebreathing and Venturi masks during exhaled smoke dispersion experiments.…”

Oxygen therapy via high flow nasal cannula in severe respiratory failure caused by Sars-Cov-2 infection: a real-life observational study

“… 31 , 32 Indeed, by correctly positioning the surgical mask on the patient’s face, hypoxemic COVID-19 subjects might benefit from HFNC, without the adjunctive risks of contamination for medical staff. 26 Hence, such risks can be minimised by observing the well-known behavioural rules that are mandatory when managing COVID-19 patients.…”

The Use of High-Flow Nasal Oxygen in the ICU as a First-Line Therapy for Acute Hypoxemic Respiratory Failure Secondary to Coronavirus Disease 2019

“…It has been suggested that the aerosolization of respiratory particles with HFNO is similar to that of other oxygen support modalities such as a standard oxygen mask ( 26 ). Similarly, a recent systematic review could not identify demonstrative evidence in either support or rejection of this concern ( 27 ). A salient risk factor for nosocomial infections of healthcare workers described during the current COVID-19 pandemic has included a lack of proper personal protective gear, and infections were more likely to occur earlier in the pandemic when preparations of personnel and resources were likely to have been archaic ( 28 ).…”