Use of High Flow Nasal Therapy to Treat Moderate to Severe Hypoxemic Respiratory Failure in COVID-19

  1. Maulin Patel
  2. Andrew Gangemi
  3. Robert Marron
  4. Junad Chowdhury
  5. Ibraheem Yousef
  6. Matthew Zheng
  7. Nicole Mills
  8. Lauren Tragesser
  9. Julie Giurintano
  10. Rohit Gupta
  11. Matthew Gordon
  12. Parth Rali
  13. Gilbert D’Alonzo
  14. David Fleece
  15. Huaqing Zhao
  16. Nicole Patlakh
  17. Gerard J. Criner
  18. for the Temple University COVID-19 Research Group
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Abstract

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of High flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.

Methods

This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from March 10, 2020, to April 24, 2020 with moderate to severe respiratory failure treated with High Flow nasal therapy (HFNT). Primary outcome was prevention of intubation.

Results

Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (±13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. SF and chest Xray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital/ventilator associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of VAP/HAP was statistically higher in the progressed to intubation group.

Conclusion

HFNT use is associated with a reduction in the rate of Invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.

Key Points

Key Question

What is the utility of High Flow Nasal Therapy (HFNT) in COVID-19 related Hypoxemic Respiratory Failure?

Bottom Line

In this retrospective analysis of moderate to severe hypoxic respiratory failure for COVID 19 patients, 67 patients (65.4%) were able to avoid intubation despite severely low SF ratio (Mean 121.9).

Why Read on

HFNT has a significant role in COVID-19 for reducing rate of intubations and associated mortality

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