Role of High Flow Nasal Cannula for Respiratory Support During Oral Feeding for COVID-19 Patients on Non-invasive Ventilation: A Case Series
Indian Journal of Critical Care Medicine
; 26:S80-S81, 2022.
Article
in English
| EMBASE | ID: covidwho-2006367
ABSTRACT
Aims and objectives:
To establish that non-invasive ventilation (NIV) can be substituted by high flow nasal cannula (HFNC) for respiratory support during oral feeding of a patient with COVID-19 patients. Materials andmethods:
This prospective case series was conducted after taking informed and written consent from the patients. Ten patients with severe COVID-19 disease requiring NIV with inspiratory pressure of <10 cm H2O, positive end-expiratory pressure of <6 cm H2O and FiO2 <0.6 were included in this study. Patients with altered consciousness, circulatory failure, or worsening acidosis were not included in the study. Patients underwent HFNC trial for 10 minutes and were screened for risk of dysphagia and aspiration using a 3-ounce water swallowing test. The patients were given a trial of HFNC for 10 minutes with a flow of 60 L/minute and FiO2 of 0.1 more than their requirement on NIV. The patients were observed for hypoxemia (SpO2 <88%) or signs of respiratory distress, e.g., increase in respiratory rate (>35/minute), laboured breathing pattern, use of accessory muscle of respiration, heart rate (>20% change), blood pressure (>20% change), perspiration, and anxiety. Then, HFNC was used for supporting respiration during oral feeding for up to 20 minutes. Feeding was started with a hypocaloric target on starting day and was increased progressively as per European Society for Clinical Nutrition and Metabolism guidelines to the target estimated caloric requirement.Results:
The HFNC support for oral feeding was successful with adequate diet intake in eight patients without desaturation/respiratory distress during oral feeding. Other than COVID-19, co-morbidities in these eight patients included diabetes mellitus, obesity, chronic obstructive pulmonary disease, coronary artery disease, and dilated cardiomyopathy. Six patients, previously on enteral nutrition using the nasogastric tube, were successfully switched to oral feeding with help of HFNC. Four patients were directly started on the oral diet with help of HFNC support. HFNC could not support respiration adequately in two of these four patients. The initial trial was successful for one of the patients and HFNC support for oral feeding was used for 3 days, but a progressive increase in ventilatory requirements resulted in failure of HFNC trial subsequent days and the patient was switched to nasogastric feeding. In another patient, the initial trial of HFNC failed due to rapid desaturation within a few minutes of the trial. The eight patients in whom HFNC was used successfully for feeding were switched to HFNC completely and discharged from the hospital after weaning off from oxygen support. The patients who failed the HFNC support for feeding required higher ventilatory requirements and needed endotracheal intubation.Conclusion:
Based on our case series, using daily screening trial of oral feeds with HFNC support in selected patients of severe COVID-19 pneumonia on NIV seems thought-provoking and should be explored for its potential in improving patient's nutrition with a positive impact on the outcome.
oxygen; water; acidosis; adult; anxiety; artificial ventilation; aspiration; assisted ventilation; blood pressure; breathing; breathing pattern; breathing rate; cardiac muscle; case report; case study; chronic obstructive lung disease; clinical article; comorbidity; conference abstract; congestive cardiomyopathy; consciousness; coronary artery disease; coronavirus disease 2019; diabetes mellitus; drug therapy; dysphagia; endotracheal intubation; enteric feeding; female; fraction of inspired oxygen; heart rate; high flow nasal cannula therapy; human; hypoxemia; male; metabolism; noninvasive ventilation; nose feeding; nutrition; obesity; outcome assessment; positive end expiratory pressure ventilation; practice guideline; prospective study; respiratory distress; shock; swallowing; sweating; treatment failure; weaning
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Indian Journal of Critical Care Medicine
Year:
2022
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS