Abstract
Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation in patients with severe COVID-19 pneumonia who do not respond to conventional oxygen treatment. Sparing Intensive Care Unit beds and reducing intubation-related complications may save lives in the pandemic era. The main drawback of HFNO and/or NIV is intubation delay. Cautious selection of patients with severe hypoxemia due to COVID-19 disease, close monitoring and appropriate employment and titration of HFNO and/or NIV can increase the rate of success and eliminate the risk of intubation delay. At the same time, all precautions to protect the healthcare personnel from viral transmission should be taken. In this review, we summarize the evidence supporting the application of HFNO and NIV in severe COVID-19 hypoxemic respiratory failure, analyse the risks associated with their use and provide a path for their proper implementation.
Highlights
During the last year, SARS-COV-2 has rapidly spread worldwide, causing millions of deaths
A proportion of 23–64% of patients with severe COVID-19 pneumonia has received High-Flow Nasal Oxygen (HFNO) [8,9,10,11,12,13,14]. This practice was based on the evidence originating from the era prior to SARS-Cov-2, which indicated that HFNO significantly reduced the need for endotracheal intubation in most patients with severe acute hypoxemic respiratory failure [15,16,17,18,19,20,21,22,23,24]
Available evidence are inconclusive with respect to the real effect of HFNO and Noninvasive Ventilation (NIV) on outcome of patients with severe hypoxemia as a result of SARS-COV-2
Summary
SARS-COV-2 has rapidly spread worldwide, causing millions of deaths. The high mortality rate along with the shortage of ICU beds render the avoidance of intubation, when feasible, essential for prognosis [1] In this context, noninvasive respiratory treatment modalities, such as High-Flow Nasal. The use of NIV for hypoxemic ARF without prior chronic respiratory disease (de novo ARF), which represents the most common life-threatening complication of COVID-19, remains debatable [7]. This is a narrative review that aims to analyse all available evidence on the effectiveness and risks of NIV and HFNO in severe COVID-19 disease, and to provide a practical path for their safe application in this group of patients. From the articles retrieved in the first round of searching, additional references were identified by a manual search among the cited references
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