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

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. MethodsThis 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. ResultsOf 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. ConclusionHFNT use is associated with a reduction in the rate of Invasive mechanical ventilation and overall mortality in patients with COVID-19 infection. Key PointsO_ST_ABSKey QuestionC_ST_ABSWhat is the utility of High Flow Nasal Therapy (HFNT) in COVID-19 related Hypoxemic Respiratory Failure? Bottom LineIn 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 onHFNT has a significant role in COVID-19 for reducing rate of intubations and associated mortality