Uses of the high-flow nasal cannula for COVID-19 patients. How does it work an what are its indications? Is it safe or patients with acute hypoxic respiratory failure?
Abstract
The coronavirus type 2 or SARS-COV-2 pandemic has held a threat over the world health system due to its high transmission rate. It has made all health systems collapse and has made evident the lack of resources such as personal protection elements and the insufficient number of ventilators for the number of patients with acute hypoxic respiratory failure. Due to his reasons, many options have been used as an alternative, being the high-flow nasal cannula one of them since it allows administering high-flow oxygen to patients with severe hypoxemia. During the COVID-19 epidemic, a concern has raised regarding this device as well as all devices used to supply oxygen to patients since they produce great dispersion of aerosols and the possibility of transmission to clinicians and staff. This has led to reject its use and give almost exclusive preference to the use of conventional cannula and mechanical ventilators with infected patients. Therefore, this study reviews the literature dealing with the high-flow nasal cannula action mechanisms, its safety for health workers and its indications for patients infected with COVID-19, as well as its advantages; amongst them, being a device that prevents the use of mechanical ventilators, which can be useful when managing patients in case of an epidemiological peak in Colombia.
Downloads
References
Wei-jie G, Zheng-yi N, Yu H, Wen-hua L, Chun-quan O, Jian-xing H et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. https://doi.org/10.1056/NEJMoa2002032
Organización Mundial de la Salud. Alocución de apertura del director general de la OMS en la rueda de prensa sobre la COVID-19 celebrada el 11 de marzo de 2020. [Internet]. 2020. Disponible en: https://bit.ly/31OQsP1
Xiaobo Y, Yuan Y, Jiqian X, Huaqing S, Jia'an X, Hong L et al. Clinical course and outcomes of critically ill patients with SARS-COV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet. 2020;8(5):475-481. https://doi.org/10.1016/S2213-2600(20)30079-5
Hui DS, Chow BK, Lo T, Tsang OTY, Ko FW, Ng SS et al. Exhaled air dispersion during high‐flow nasal cannula therapy versus CPAP via different masks. Eur Respir J. 2019;53(4):1802339. https://doi.org/10.1183/13993003.02339-2018
Ip M, Tang JW, Hui DSC, Wong ALN, Chan MTV, Joynt GM et al. Airflow and droplet spreading around oxygen masks: a simulation model for infection control research. Am J Infect Control. 2007;35(10):684-689. https://doi.org/10.1016/j.ajic.2007.05.007
Scheaua FD. Theoretical approaches regarding the Venturi effect. Hidraulica. 2016;(3):69-72. Disponible en: https://bit.ly/3e0OpfE
Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103(10):1400-1405. https://doi.org/10.1016/j.rmed.2009.04.007
Lodeserto FJ, Lettich TM, Rezaie SR. High-flow nasal cannula: mechanisms of action and adult and pediatric indications. Cureus. 2018;10(11):e3639. https://doi.org/10.7759/cureus.3639
Whittle J, Pavlov I, Sacchetti AD, Atwood C, Rosenberg MS. Respiratory support for adult patients with COVID‐19. JACEP Open. 2020;1(2):95-101. https://doi.org/10.1002/emp2.12071
Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E et al. Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease (COVID-19). Intensive Care Med. 2020;(46):854-887. DOI: https://doi.org/ggqp2p
National Health Service (NHS). Guidance for the role and use of non-invasive respiratory support in adult patients with COVID-19 (confirmed or suspected). Version 3. 2020. Disponible en: https://bit.ly/3jzRFjo
World Health Organization. Operational considerations for case management of COVID-19 in health facility and community. Interim guidance World Health Organization. Pediatr Med Rodz. 2020;16(1):27-32. https://doi.org/10.15557/PiMR.2020.0004
Li J, Fink JB, Ehrmann S. High-flow nasal cannula for COVID-19 patients: low risk of bio-aerosol dispersion. Eur Respir J. 2020;55(5):2000892. https://doi.org/10.1183/13993003.00892-2020
Cinesi C, Peñuelas Ó, Luján M, Egea C, Masa JF, García J et al. Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-COV-2. Arch. bronconeumol. 2020;56(2):11-18. https://doi.org/10.1016/j.arbres.2020.03.005
Parke RL, McGuinness SP, Eccleston ML. A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients. Respir Care. 2011;56(3):265-270. https://doi.org/10.4187/respcare.00801
Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care. 2012;27(3):324.e9-324.e13. https://doi.org/10.1016/j.jcrc.2011.07.075
Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;(372): 2185-2196. https://doi.org/10.1056/NEJMoa1503326
Rochwerg B, Granton D, Wang DX, Helviz Y, Einav S, Frat JP et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019;(45):563-572. https://doi.org/10.1007/s00134-019-05590-5
Ni YN, Luo J, Yu H, Liu D, Liang BM, Liang ZA. The effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis. Am J Emerg Med. 2018;36(2): 226-233. https://doi.org/10.1016/j.ajem.2017.07.083
Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernández G et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med. 2019;199(11):1368-1376. https://doi.org/10.1164/rccm.201803-0589OC
Zucman N, Mullaert J, Roux D, Roca O, Ricard JD. Prediction of outcome of nasal high flow use during COVID-19-related acute hypoxemic respiratory failure. Intensive Care Med. 2020;(46):1924-1926. https://doi.org/10.1007/s00134-020-06177-1
