Clinical Experience Using High-flow Nasal Cannula for Moderate COVID-19 Pneumonia

• Published in: Japanese Journal of Infection Prevention and Control Vol. 38; no. 2; pp. 68 - 74
• Main Authors: SHIGEMATSU, Michio, KUSUHARA, Mizuki, SAKANO, Yuta, NAKAI, Isako, HAYASHI, Michio, ONO, Hiroko, KADOTANI, Tatsuya, FUJIWARA, Hiroko, KOUFUKU, Tomoki, SAKAMOTO, Etsuko
• Format: Journal Article
• Language: English; Japanese
• Published: Japanese Society for Infection Prevention and Control 25.03.2023
• Subjects: COVID-19; HFNC; indoor ventilation; infection control; overwhelmed hospital
• ISSN: 1882-532X; 1883-2407
• DOI: 10.4058/jsei.38.68

In Japan, critical care beds for ventilatory management were limited during the coronavirus disease 2019 (COVID-19) pandemic. Our hospital treated moderate COVID-19 pneumonia and began using high-flow nasal cannula (HFNC) for patients with the aim of reducing transfers to critical care hospitals. We conducted a retrospective study to determine the outcomes, influencing factors, and effects of avoiding intubation using HFNC. HFNC was implemented when SpO2 was <93% using a simple mask (O2, 5 L/min). We performed intubation when oxygenation was not maintained at 60%-70% FiO2. HFNC was used in negative-pressure rooms or patient rooms at a distance from the green zone. In addition to contact and droplet precautions, staff members undertook precautions against the airborne spread of COVID-19. Thirty-four patients used HFNC and scheduled for intubation when respiratory failure progressed. In these patients, 20 (58.8%) were relieved by HFNC alone and 14 (41.2%) were intubated. Compared to the intubation criteria in the early phase of the pandemic, we could reduce ventilator use by a total of 151 person-days. In hospitals that treat moderate COVID-19, using HFNC for severe COVID-19 pneumonia with certain infection control can be safe, help patients avoid intubation, and improve the conditions in overwhelmed hospitals.