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

Abstract

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Non-invasive respiratory support in the management of acute COVID-19 pneumonia: considerations for clinical practice and priorities for research

“…Search terms yielded 84 articles relating to a total of 13 140 patients after exclusion of duplicates, and after screening titles, abstracts, and full text for relevance specifically to outcomes with the use of NIRS in patients with COVID-19 ( appendix p 1 ). 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ,…”

“…Other than two multicentre RCTs from Italy and the UK, 38 , 95 22 prospective and 61 retrospective observational studies were identified, reporting a median of 71 patients (IQR 40–127) per study. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ,…”

“…The median duration of NIRS, where reported, is shown in tables 1–3. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , …”

The Berlin definition of acute respiratory distress syndrome: should patients receiving high-flow nasal oxygen be included?

“… 9 , 10 HFNO also increases carbon dioxide excretion and diminishes work of breathing. 8 , 11 , 12 , 13 , 14 During the COVID-19 pandemic, HFNO has been widely used to support patients with bilateral pulmonary infiltrates and hypoxaemia due to SARS-CoV-2 pneumonia, 15 , 16 , 17 including those managed in resource-limited settings 18 and patients with severe COVID-19-associated ARDS managed in the prone position, 19 who typically meet all other Berlin diagnostic criteria for ARDS other than the requirement for invasive or non-invasive mechanical ventilation.

Figure Proposed expansion of the Berlin definition of ARDS ARDS=acute respiratory distress syndrome.

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The Natural History of a Patient With COVID-19 Pneumonia and Silent Hypoxemia

“…Reports of first-line use of highflow nasal cannula oxygen has not demonstrated inferior outcomes, nor has the timing of intubation, suggesting a significant portion of patients could benefit from a trial of therapy and eventually avoid intubation. [11][12][13][14] Other therapies, such as systemic corticosteroids, confer a mortality benefit in those patients with COVID-19 who require oxygen or mechanical ventilation, but their impact on the progression of respiratory failure and need for intubation are undetermined.…”