Affiliation:
1. Respiratory Care Services Division, Specialized Therapy and Clinical Services Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Abstract
Abstract
Introduction:
The primary clinical presentation of the COVID-19 pandemic is severe acute respiratory illness. The primary management strategy for COVID-19 patients is supportive care. In the early times of the pandemic, there was uncertainty regarding the use of high-flow nasal cannula (HFNC) among COVID-19 patients in the Western communities, thus increasing early intubation rates and potentially associated harms such as sedation complications and prolonged intensive care unit stay. In June 2020, HFNC was introduced in Johns Hopkins Aramco Healthcare as the primary supportive therapy to manage hypoxemic COVID-19 patients and to minimize the risks associated with endotracheal intubation.
Methods:
We have performed a retrospective study design for subjects treated for acute hypoxemic respiratory failure secondary to COVID-19 and managed with HFNC. Patients included in the study if they were 14-year-old or older, had a laboratory-confirmed diagnosis of COVID-19 by polymerase chain reaction testing, and were treated with HFNC for at least 6 h. Patients were excluded if endotracheal intubation was performed before initiation of HFNC, required elective intubation or patient on do-not-resuscitate status. Patients on alternation modality between HFNC and noninvasive ventilation (NIV) were subgrouped in data analysis.
Results:
During the study period between May 31, 2020, and November 31, 2020, our search identified 122 subjects with respiratory failure secondary to COVID-19 who required the use of HFNC, 18 patients were excluded due to the exclusion criteria, 50 patients were started on, improved and weaned off HFNC, 30 patients were on alternation modality between HFNC and NIV, improved and weaned off and 24 patients failed HFNC and got intubated.
Conclusions:
In this retrospective study, utilizing HFNC in subjects with hypoxemic respiratory failure related to COVID-19 was found to be effective to reduce the intubation risk by 76.9%.