HFNC is a potential feasible rescue respiratory treatment strategy for frail elderly COVID-19 patients.
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Using HFNC in fragile COVID-19 patients in the wards results in a survival rate of 25%.
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For fragile COVID-19 ICU and frail HFNC patients in the wards mortality is comparable.
Abstract
Background
Invasive mechanical ventilation is the treatment of choice in COVID-19 patients when hypoxemia persists, despite maximum conventional oxygen administration. Some frail patients with severe hypoxemic respiratory failure are deemed not eligible for invasive mechanical ventilation.
Objectives
To investigate whether High-flow nasal cannula (HFNC) in the wards could serve as a rescue therapy in these frail patients.
Methods
This retrospective cohort study included frail COVID-19 patients admitted to the hospital between March 9th and May 1st 2020. HFNC therapy was started in the wards. The primary endpoint was the survival rate at hospital discharge.
Results
Thirty-two patients with a median age of 79.0 years (74.5–83.0) and a Clinical Frailty Score of 4 out of 9 (3–6) were included. Only 6% reported HFNC tolerability issues. The overall survival rate was 25% at hospital discharge.
Conclusions
This study suggests that, when preferred, HFNC in the wards could be a potential rescue therapy for respiratory failure in vulnerable COVID-19 patients.