The Impact of High-Flow Nasal Cannula Use on Patient Mortality and the Availability of Mechanical Ventilators in COVID-19.
Ann Am Thorac Soc
; 18(4): 623-631, 2021 04.
Artículo
en Inglés
| MEDLINE | ID: covidwho-858614
ABSTRACT
Rationale How to provide advanced respiratory support for coronavirus disease (COVID-19) to maximize population-level survival while optimizing mechanical ventilator access is unknown.Objectives:
To evaluate the use of high-flow nasal cannula for COVID-19 on population-level mortality and ventilator availability.Methods:
We constructed dynamical (deterministic) simulation models of high-flow nasal cannula and mechanical ventilation use for COVID-19 in the United States. Model parameters were estimated through consensus based on published literature, local data, and experience. We had the following twooutcomes:
1) cumulative number of deaths and 2) days without any available ventilators. We assessed the impact of various policies for the use of high-flow nasal cannula (with or without "early intubation") versus a scenario in which high-flow nasal cannula was unavailable.Results:
The policy associated with the fewest deaths and the least time without available ventilators combined the use of high-flow nasal cannula for patients not urgently needing ventilators with the use of early mechanical ventilation for these patients when at least 10% of ventilator supply was not in use. At the national level, this strategy resulted in 10,000-40,000 fewer deaths than if high-flow nasal cannula were not available. In addition, with moderate national ventilator capacity (30,000-45,000 ventilators), this strategy led to up to 25 (11.8%) fewer days without available ventilators. For a 250-bed hospital with 100 mechanical ventilators, the availability of 13, 20, or 33 high-flow nasal cannulas prevented 81, 102, and 130 deaths, respectively.Conclusions:
The use of high-flow nasal cannula coupled with early mechanical ventilation when supply is sufficient results in fewer deaths and greater ventilator availability.Palabras clave
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
MEDLINE
Asunto principal:
Terapia por Inhalación de Oxígeno
/
Respiración Artificial
/
Cánula
/
COVID-19
Tipo de estudio:
Estudio experimental
/
Estudio pronóstico
Tópicos:
Covid persistente
Límite:
Adolescente
/
Adulto
/
Anciano
/
Femenino
/
Humanos
/
Masculino
/
Middle aged
/
Young_adult
País/Región como asunto:
America del Norte
Idioma:
Inglés
Revista:
Ann Am Thorac Soc
Año:
2021
Tipo del documento:
Artículo
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