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This article reviews the available published literature on experience with using a heated high-flow nasal canula (HHFNC) for the management of severe acute respiratory distress syndrome (ARDS) in COVID-19. The authors summarize the advantages of HHFNC, the current use patterns in management of COIVD-19, active concerns regarding its use, and novel techniques such as use of HHFNC with awake prone positioning.
Not all patients with severe ARDS from SARS-CoV-2 are appropriate candidates for HHFNC, and careful patient selection is necessary. The ROX index (defined as the ratio of SpO2/FiO2 to respiratory rate) may be a useful discriminator of patients who are in early danger of failing HHFNC.
– Kolene E. Bailey, MD
This abstract is available on the publisher's site.
Infection with the novel 2019 coronavirus (SARS-CoV-2) is associated with the development of a viral pneumonia with severe hypoxemia and respiratory failure. In many cases these patients will require mechanical ventilation; but in others the severity of disease is significantly less and may not need invasive support. High flow nasal cannula (HFNC) is a widely used modality of delivering high concentrations of oxygen and airflow to patients with hypoxemic respiratory failure, but its use in patients with SARS-CoV-2 is poorly described. Concerns with use of HFNC have arisen including aerosolization of viral particles to healthcare workers (HCW) to delaying intubation and potentially worsening of outcomes. However, use of HFNC in other coronavirus pandemics and previous experimental evidence suggest HFNC is low risk and may be effective in select patients infected with SARS-CoV-2. With the significant increase in resource utilization in care of patients with SARS-CoV-2, identification of those that may benefit from HFNC allowing allocation of ventilators to those more critically ill is of significant importance. In this manuscript, we review pertinent literature regarding the use of HFNC in the current SARS-CoV-2 pandemic and address many concerns regarding its use.