Clinical observation of high-flow nasal cannula with non-rebreather mask use on severe or critically ill COVID-19 diabetic patients

Background and aims

Prevalence of diabetes is a vital factor in COVID-19’s clinical prognosis. This study aimed to investigate and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without non-rebreather mask (NRM) use on critical COVID-19 patients with/without diabetes.

Methods

For analysis and comparison, epidemiological, biochemical, and clinical data were collected from 240 HFNC (±NRM) treated severe and critical COVID-19 patients (diabetic = 136; non-diabetic = 104) admitted into ICUs of five hospitals in Chattogram, Bangladesh.

Results

59.1% of patients with fever had diabetes (p=0.012). ICU stay was longer for diabetic patients (9.06±5.70) than non-diabetic patients (7.41±5.11) (p=0.020). Majority of the hypertensive patients were diabetic (68.3%; p<0.001). Majority of diabetic patients (70.4%; p<0.005) had elevated creatinine levels. Partial pressure of oxygen (mmHg) after HFNC (only) administration was significantly (p=0.031) higher in non-diabetic patients (69.30±23.56) than in diabetic patients (61.50±14.49). Diabetic (62.64±13.05) and non-diabetic patients (59.40±13.22) had almost similar partial pressure of oxygen (mmHg) from HFNC with NRM. Patients with elevated RBS required NRM with HFNC five times (AOR=5.1, 1.2-20.8) higher than others. Besides age, and hypertension were significantly associated with the HFNC+NRM treated diabetic patients. Factors those affected the HFNC only treated patients were fever and impaired glucose tolerance.

Conclusions

The results of this study imply that oxygen supply with HFNC and NRM may be beneficial for the elderly/hypertensive diabetic patients with COVID-19 associated AHRF; and that increased blood glucose level could be a determinant for the need of HFNC + NRM treatment.

Highlights

• Elderly diabetic patients required both HFNC and NRM to increase oxygen saturation.

• Hypertension may be a factor for diabetic patients with COVID-19 requiring HFNC and NRM together.

• ‘HFNC + NRM’-combination therapy might be needed when blood glucose levels rise.