High-flow Nasal Cannula therapy: A feasible treatment for vulnerable older COVID-19 patients on the wards

Abstract

Background: In the midst of the COVID-19 crisis, many frail elderly adults were admitted to our hospital with COVID-19. Some faced severe respiratory failure but were not eligible for invasive mechanical ventilation, due to frailty, functional status, comorbidity or wish of the patient. Our main objective was to investigate whether High-flow nasal cannula (HFNC) treatment on the wards could be an effective alternative treatment for these patients.Methods: A retrospective cohort study amongst COVID-19 adult patients with respiratory failure defined as persisting hypoxemia despite maximum conventional oxygen administration requiring invasive mechanical ventilation in the Intensive Care Unit (ICU) but being treated with HFNC as they were non-eligible due to frailty or wish of the patient.Results: The study included 32 patients between March 9th and May 1st, 2020. The median age was 79.0 years (74.5-83.0) with a median of three comorbidities (3-4) and a median Clinical Frailty Score of 4 out of 9 (3-6). The median SpO2/FiO2 Ratio was 157.5 indicating moderate ARDS. Overall survival rate in the HFNC cohort was 25%. Age (80.5 (78.0-84.3) vs 69.5 (65.5-74.3) p=0.0040) and hypertension (92% vs 25%, p=0.0008) were correlated with mortality.Conclusion: This study suggests that HFNC could be an effective last resort respiratory management strategy for respiratory failure in vulnerable elderly COVID-19 patients who failed on conventional high dose oxygen supply and are not eligible for invasive mechanical ventilation.