Usage of high-flow oxygen therapy outside the intensive care unit: a possibility to delay or prevent the need for mechanical ventilation among COVID-19 patients

Abstract

Previous studies have shown the advantage of non-invasive over prompt invasive approaches in the treatment of patients with severe COVID-19. The dramatic situation of the pandemic raised the legitimacy of using high-flow oxygen therapy (HFO) outside the intensive care unit (ICU). The authors investigated ways of its best practice. They retrospectively analysed documentation of patients receiving HFO in the first three waves of the pandemic on the Infectious Diseases' Ward (n = 193), to record oxygen saturation levels before and during HFO, number of treatment days. Discharge at home, transfer to intensive care unit and death were chosen as the three possible endpoints. The period of the third wave (standard therapy established) was analysed separately. As the pandemic progressed, the usage of MET (Medical Emergency Team) grew to 811%, the number of HFO devices grew by 567%. With concomitant standard COVID-19 therapy, 18.7% of the patients requiring HFO could be discharged home, avoiding invasive solutions. With optimal workload and experience, this ratio reached 36%. Among patients later discharged home, the median oxygen saturation before HFO was 78%, the total time with HFO was 8,5 days. The occurrence of pneumothorax or pneumomediastinum was 1%. The difference in oxygen saturation before HFO between the patients later discharged home and those transferred to ICU was not significant. The results support the assumption that low oxygen saturation at admission does not inevitably require invasive intervention in COVID-19 patients, high-flow oxygen therapy can also be performed by non-ICU professionals as ante-room to the ICU, under regular supervision by ICU experts, so that the deterioriation of the patients' condition is discovered appropriately. Orv Hetil. 2022; 163(7): 254-266.