High Flow Nasal Cannula: A sigh of relief for fragile COVID-19 patients?

-Sashreek Ganguli, Amity University Kolkata

One- fifth of the COVID-19 patients in today’s world develop critical interstitial pneumonia characterized by bilateral interstitial infiltrates, leading to Acute Respiratory Distress Syndrome (ARDS) and respiratory failure. These patients while under treatment show acute hypoxemia and often have persistent dyspnea, despite the administration of oxygen flows>10–15l/min through a facial mask with reservoir. Under all these conditions, other methods, such as high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) support, or non-invasive mechanical ventilation (NIV), may be useful.

The aforementioned methods were found to be more comfortable for the patients and need to be utilized more frequently as there is an increasing scarcity in the number of Intensive Care Units, physicians also discovered that invasive intubation leads to increased mortality, having said this, Aerosol generating procedures (AGP) like NIV and HFNC pose a certain amount of threat to health care workers as they may be infected while performing these procedures but,  studies suggest that use of high-energy particulate accumulator (HEPA) filters, negative– pressure rooms and full PPE, are enough to protect medical and nursing staff. Hence, methods like HFNC that involve the provision of humidified and heated oxygen at high flows through nasal cannulas are sufficiently useful in providing non-invasive ventilation support to the patients in the practical world.

Moreover, a small trial from China indicated HFNC as the most common ventilation support for COVID-19 patients with pneumonia and showed that only 7 out of 17 patients treated with HNFC showed treatment failure. Thus, results convincingly suggest that, in managing COVID-19-associated ARDS, HFNC can be usefully utilized, especially for the elderly.

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

Giada Procopio* , Anna Cancelliere*, Enrico Maria Trecarichi, Maria Mazzitelli, Eugenio Arrighi, Graziella Perri, Francesca Serapide, Corrado Pelaia , Elena Lio, Maria Teresa Busceti, Maria Chiara Pelle, Marco Ricchio, Vincenzo Scaglione, Chiara Davoli, Paolo Fusco, Valentina La Gamba, Carlo Torti§ and Girolamo Pelaia§

https://doi.org/10.1177%2F1753466620963016

Ther Adv Respir Dis 2020, Vol. 14: 1–10

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