Elsevier

Heart & Lung

Volume 50, Issue 5, September–October 2021, Pages 654-659
Heart & Lung

High-flow Nasal Cannula therapy: A feasible treatment for vulnerable elderly COVID-19 patients in the wards

https://doi.org/10.1016/j.hrtlng.2021.04.008Get rights and content

Highlights

  • HFNC is a potential feasible rescue respiratory treatment strategy for frail elderly COVID-19 patients.

  • Using HFNC in fragile COVID-19 patients in the wards results in a survival rate of 25%.

  • 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.

Keywords

COVID-19
Intensive care unit
High-flow Nasal Cannula
Frailty

Abbreviations

ACE
Angiotensine Converting Enzyme
ALAT
Allanine transaminase
ARDS
Acute Respiratory Distress Syndrome
ASAT
Aspartate transaminase (ASAT)
BMI
Body Mass Index
CK
Creatine kinase
COPD
Chronic Obstructive Pulmonary Disease
COVID-19
Coronavirus disease 2019
CT
Computed tomography
eGFR
estimated Glomerular Filtration Rate
FFP-2
Filtering Facepiece Particles-2
FiO2
Fraction of inspired oxygen
HFNC
High-flow nasal cannula
ICU
Intensive Care Unit
LD
Lactate dehydrogenase
NIV
Noninvasive Ventilation
SARS-CoV-2
Severe Acute Respiratory Syndrome Coronavirus 2
SOFA
Sequential Organ Failure

Cited by (0)

1

These authors contributed equally.

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