Clinical experience with high-flow nasal cannula for COVID-19 patients in Japan

Abstract

Introduction: We are amidst a coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2. Oxygen administration is crucial in COVID-19 treatment, and high-flow nasal cannula (HFNC) prevents the need for intubation in patients with acute respiratory failure unlike conventional oxygen therapy. HFNC use for COVID-19 patients is limited owing to concerns of aerosol generation, therefore we aim to report our single-center experience with HFNC for COVID-19 patients.

Methods: A retrospective observational study on the use of HFNC for COVID-19 patients admitted to our institution from January 2020 to January 2021. 514 patients were included and divided into HFNC success or HFNC failure, depending on whether intubation could be avoided. Compared the basement characteristics and sequential change after HFNC therapy in both groups.

Results: Of 514 patients, 37 patients (7.2%) implemented HFNC due to deterioration. Of these, 24 patients (64.9%) were successfully managed, 4 (10.8%) were escalated to non-invasive ventilation, 7 (18.9%) were required intubation, 2 (5.4%) were palliated. The median duration of HFNC for HFNC success and HFNC failure patients was 5 days and 4 days, respectively. The median maximum FiO2 was 60 % and 100 %, respectively. In terms of sequential change of vital signs, SpO2/ FiO2 and heart rate improved in both groups, after 2–6 hours of HFNC use. All patients administered HFNC used a private negative pressure room. Nosocomial infections were not apparently reported during the study period.

Conclusions: The appropriate use of HFNC in COVID-19 patients is beneficial because it can reduce the aggravation and intubation rate.