UChicago: Doctors See ‘Truly Remarkable’ Success Using High-Flow Nasal Cannulas to Treat COVID-19
April 25th, 2020Via: UChicago Medicine:
Doctors at the University of Chicago Medicine are seeing “truly remarkable” results using high-flow nasal cannulas rather than ventilators and intubation to treat some COVID-19 patients.
High-flow nasal cannulas, or HFNCs, are non-invasive nasal prongs that sit below the nostrils and blow large volumes of warm, humidified oxygen into the nose and lungs.
A team from UChicago Medicine’s emergency room took dozens of COVID-19 patients who were in respiratory distress and gave them HFNCs instead of putting them on ventilators. The patients all fared extremely well, and only one of them required intubation after 10 days.
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The HFNCs are often combined with prone positioning, a technique where patients lay on their stomachs to aid breathing. Together, they’ve helped UChicago Medicine doctors avoid dozens of intubations and have decreased the chances of bad outcomes for COVID-19 patients, said Thomas Spiegel, MD, Medical Director of UChicago Medicine’s Emergency Department.
“The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%, so it’s been fascinating and wonderful to see,” Spiegel said.
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This approach is not without risk, however. HFNCs blow air out, and convert the COVID-19 virus into a fine spray in the air. To protect themselves from the virus, staff must have proper personal protective equipment (PPE), negative pressure patient rooms, and anterooms, which are rooms in front of the patient rooms where staff can change in and out of their safety gear to avoid contaminating others.
There has been a large amount of great Covid-19 coverage on Cryptogon—two weeks ago there was a posting well worth a re-view:
https://www.cryptogon.com/?p=57989#comments
Even though intubation/respirator therapy for Covid-19 has a terribly high mortality rate, and less invasive therapies like HFNC (High Flow Nasal Cannula) and HVNI (High Velocity Nasal Insufflation) have been shown to be very effective by hospitals like UChicago Medicine, they are very underused due to the virus aerosol transmission risk. To mitigate the risk,
“staff must have proper personal protective equipment (PPE), negative pressure patient rooms, and anterooms, which are rooms in front of the patient rooms where staff can change in and out of their safety gear to avoid contaminating others.”
Difficult to implement worldwide quickly, but even simple things like putting surgical masks on patients receiving these therapies is a big improvement:
https://vapotherm.com/blog/transmission-assessment-report/