High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review

Abstract

Purpose of Review This review instantiates the efficacy and safety of HFNC in the context of COVID-19 pandemic. Recent Findings Globally, the healthcare system is facing an unprecedented crisis of resources due to the 2019 novel coronavirus disease (COVID-19) pandemic. Fever, cough, dyspnea, myalgia, fatigue, and pneumonia are the most common symptoms associated with it. The incidence of invasive mechanical ventilation in ICU patients ranges from 29.1 to 89.9%. Supplemental oxygen therapy is the main stay treatment for managing hypoxemic respiratory failure. The high-flow nasal cannula (HFNC) is a novel non-invasive strategy for better oxygenation and ventilation in critically ill patients. In this grim scenario, a reduction in mechanical ventilation by means of HFNC is of prime interest Summary HFNC is considered an aerosol-generating intervention with the risk of viral aerosolization with a concern of potential nosocomial transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, there is no consensus regarding the use of HFNC in novel coronavirus-infected pneumonia (NCIP). HFNC seems to be an effective and safe treatment modality in acute respiratory failure with optimal settings and selection of ideal patients.

Delayed intubation associated with in-hospital mortality in patients with COVID-19 respiratory failure who fail heated and humified high flow nasal canula

“…Our study found that among patients with acute respiratory failure due to COVID-19 pneumonia who were initially treated with HFNC but subsequently intubated, delayed intubation beyond twenty-four hours was associated with an increased in-hospital mortality. Initial concerns about potential aerosolization of SARS-CoV-2 viral particles and healthcare personnel infection limited the use of HFNC for patients presenting with acute respiratory failure (ARF) due to COVID-19 pneumonia early in the pandemic [ 2 – 6 ]. However, as infectious risks were better understood, hospital strain escalated, and clinicians gained more experience with HFNC, use of this modality increased.…”

“…During the peak of the SARS-CoV-2/COVID-19 pandemic, there was a dramatic increase in the demand for advanced respiratory support modalities such as non-invasive positive pressure ventilation (NiPPV), heated and humidified high flow nasal canula (HFNC), as alternatives to invasive mechanical ventilation (IMV) [ 1 ]. In the early phase of the pandemic, concerns about potential aerosolization of SARS-CoV-2 viral particles and healthcare personnel infection limited the use of NiPPV and HFNC for patients presenting with acute respiratory failure (ARF) due to COVID-19 pneumonia [ 2 – 6 ]. However, during subsequent waves of the pandemic, there was a better appreciation of the transmission risk associated with SARS-CoV-2 hence a gradual and sustained increased in the use of these non-invasive modalities for ARF [ 7 – 10 ].…”

Stratification of COVID-19 Patients with Moderate-to-Severe Hypoxemic Respiratory Failure for Response to High-Flow Nasal Cannula: A Retrospective Observational Study

“…Therefore, the relevant therapeutic question is whether to employ CPAP or HFNC in certain circumstances and whether some patients with specific characteristics may benefit from one support over another to allocate the appropriate respiratory support to the right patient [40,41]. Indeed, recent trials on CPAP in COVID-19 patients with ARDS, despite lacking a head-to-head design, are improving the selection and stratification criteria and providing further promising data on the safety profile [42][43][44][45][46].…”

Awake Prone-Positioning in Patients on Non-Invasive Ventilation for Management of SARS-CoV-2 Pneumonia: A Systematic Review

“…The HFNC is another non-invasive strategy that gained popularity during these COVID times. However, its role has been controversial, and there is no consensus in this context for the use of HFNC in COVID-19 pneumonia amongst various eminent organizations [ 35 ]. Considering this, we restricted this systematic review to NIV only.…”