Use of high-flow nasal oxygenation outside COVID-19: a rural hospital experience

ABSTRACT

Background: Before the COVID-19 pandemic, there was an increasing interest in the use of high-flow nasal oxygenation (HFNO) due to the way it delivers oxygen and because of its impact on respiratory mechanics. Its use extends from the operating room, e.g. pre-oxygenation, apnoeic oxygenation in ENT surgery, electroconvulsive therapy, to the emergency room and intensive care unit, e.g. acute respiratory failure, cardiogenic shock in adults and paediatrics. It has also been advocated as a useful method to prevent reintubation. However, it has not always shown to be a superior approach to other oxygenation methods. Currently, the medical literature is inundated with the use of HFNO in the management of COVID-19. Yet, the picture may differ outside this ambit. Methods: We describe two complex cases in which this therapy was used and was decisive toward a positive outcome. Results: We describe two complex cases in which HFNO therapy was used and was decisive toward a positive outcome. In our first described case, it was an effective tool to bypass the need of endotracheal intubation in a high-risk OSA patient. In the second case the traditional epidural with invasive or noninvasive ventilation was challenged. The higher tolerability of HFNO, absence of sedation, better mobility and easier access to enteral nutrition resulted in the quick, successful recovery of the patient despite the combination of chronic restrictive pulmonary disease and severe thoracic-abdominal trauma. Conclusion: In our opinion, both cases may illustrate a significant potential for the use of HFNO in different clinical scenarios.