COVID-19 disease: Non-Invasive Ventilation and high frequency nasal oxygenation

Compared to NIPPV, HFNC is more dangerous regarding aerosol dispersion and contamination of healthcare personnel: we are not sure

“…Unfortunately, these recommendations lacked specific evidence. Recent societies in the UK and Italy have moved away from the use of HFNC to NIPPV because of a lack of demonstrated efficacy with HFNC, the high oxygen use, and demonstration that in patients that failed HFNC secondary to hypoxemia; these patients were rescued with NIPPV avoiding invasive ventilation [8,9].…”

“…As the authors point out, although the risk of transmission of bacterial transmission with HFNC is low, the risk of viral spread in live patients (rather than inanimate models) has not been studied. In fact, a number of healthy volunteer studies have been performed showing changes and increases in droplet dispersion with increasing flow rates with HFNC through the use of a smokelaser illumination technique on a human patient simulators [8,9]. Likewise, NIPPV, when delivered using a tight-fitting mask, dual limb circuitry with a filter on the expiratory limb on a critical care ventilator may demonstrate decreased dispersion and be very safe [9].…”

“…Presently, there is a paucity of live COVID-19 patient studies evaluating the aerosolization of the virus in a patient that changes position (moves from supine to prone, or from standing to sitting), generates differing minute ventilations, uses mouth versus nasal breathing, and similar relevant factors. Unfortunately, studies from Europe and China have demonstrated a close to 50% failure rate of HFNC and need for mechanical ventilation [9].…”

Ventilatory Management of COVID-19-related ARDS: Stick to Basics and Infection Control

“…13 , 14 The use of NIV may improve oxygenation in AHRF and temporarily reduce work of breathing but has no effect on natural disease progression, and may even delay in intubation and IMV in nonexpert hands. 15 , 16 There is also a risk of further worsening of the lung injury, especially with higher tidal volumes generated spontaneously in case of inappropriate settings of NIV. 16 , 17 In the LUNG-SAFE study, NIV use was associated with higher ICU mortality in patients with moderate-to-severe ARDS (PaO 2 /FiO 2 < 150 mm Hg).…”

“… 15 , 16 There is also a risk of further worsening of the lung injury, especially with higher tidal volumes generated spontaneously in case of inappropriate settings of NIV. 16 , 17 In the LUNG-SAFE study, NIV use was associated with higher ICU mortality in patients with moderate-to-severe ARDS (PaO 2 /FiO 2 < 150 mm Hg). 18 …”