High-flow nasal oxygen (HFNO) for patients with Covid-19 outside intensive care units

Abstract

Introduction High-flow nasal oxygen (HFNO) has traditionally only been used in intensive care units (ICU) especially in acute respiratory distress syndrome (ARDS). Methods We studied the use of HFNO at Södersjukhuset, Stockholm, in patients with moderate to severe ARDS related to Covid-19 as well as its benefits both for patients and to offload the ICU. The patients were observed with frequent controls to assess the need of ICU in case of deterioration. Results We studied 41 patients with HFNO treatment either as primarily treatment (Step-Up) or after stabilizing in the ICU (Step-Down). The average duration for treatment with HFNO was 5.6 days. Of these patients 55% were discharged home or to geriatric rehabilitation and 10% avoided ICU completely. The usage of HFNO saved in total 229 days in the ICU. Mortality was higher among elderly patients, and patients with comorbidities (mainly hypertension and obesity). Discussion and conclusion HFNO treatment is feasible and efficient for patients with Covid-19, saving resources in the ICU and offering additional advantages as waken proning and fewer complications compared to traditional ICU care. It requires however frequent controls as deterioration is recurrent.

Use of high flow nasal cannula in patients with acute respiratory failure in general wards under intensivists supervision: a single center observational study

“…Recently, Issa et al reported on the safety and feasibility of HFNC oxygenation therapy as primary treatment and after ICU stabilization in COVID-19 patients. The authors emphasized how the use of HFNC can be effective in hypoxic patients, reducing the workload for already overburdened ICUs [ 12 ].…”

Catastrophic COVID-19 Delta Variant Surge in French West Indies: Report of an ICU Triage Policy*

“…The results of strategies for lowering mortality among COVID-19-infected patients remain unclear (28,29). Due to a massive influx of patients during the pandemic, HFNO has been used outside the ICU to save resources (28), with seemingly good results (30). However many studies have reported that HFNO and awake prone positioning only delay the time to mechanical ventilation (29)(30)(31)(32), without reducing the rate of oxygenation failure.…”

“…Due to a massive influx of patients during the pandemic, HFNO has been used outside the ICU to save resources (28), with seemingly good results (30). However many studies have reported that HFNO and awake prone positioning only delay the time to mechanical ventilation (29)(30)(31)(32), without reducing the rate of oxygenation failure. The increased mortality rate among late ICU admission patients in our study should serve as a warning to physicians to reconsider ICU admission when possible for HNFO patients managed outside the ICU.…”

High flow nasal cannula in older vulnerable COVID-19 patients: A missed opportunity?

“…We read with great interest the article by Issa and Söderberg [ 1 ], about how high flow oxygen through nasal cannula (HFNC) is feasible and efficient for patients with COVID-19 outside the ICU and therefore saves resources within the ICU, and the article by Ferrer et al [ 2 ], in which they show the ROX index predicts HFNC success on the one hand and that HFNC successfully prevents endotracheal intubation (ETI) and death in patients with COVID-19. Both articles allow to take a moment to further reflect on the use of HFNC in patients with COVID-19 and in times of limited healthcare resources, especially in those who are older, vulnerable and/or frail.…”

“…Generally, HFNC seems to reduce the need for invasive ventilation in patients with acute hypoxemic respiratory failure without impacting mortality [ 4 ]. However, evidence supporting the use of HFNC in hospitalized older COVID-19 patients with respiratory failure remains limited [ 1 , 2 , [5] , [6] , [7] , [8] ]. Anticipating shortages and providing optimal care for older patients considered non-eligible for ETI, we have conducted a proof-of-principle study to compare the effect of HFNC with COT on 30-day survival (primary outcome), breathing frequency and peripheral oxygen saturation (secondary outcomes) in older patients with severe COVID-19.…”