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Research
issa issa
Sodersjukhuset AB
Corresponding Author
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Introduction
The usage of high-flow nasal oxygen (HFNO) has traditionally been located in intensive care units (ICU). As the Covid-19 pandemic continues to be a challenge to the whole world, health care providers are trying to manage space in the ICU. HFNO is well studied for usage in acute respiratory distress syndrome (ARDS). We tried to study the usage of HFNO in patients with moderate to severe ARDS related to Covid-19 outside the ICU as well as its benefits both for patients and to offload the ICU.
Methods
We started a project to use HFNO in the ward of infectious diseases at Södersjukhuset, Stockholm. Patients with Covid-19 who needed HFNO were transferred to this ward after assessment from anesthesiologists or intensive care doctors. The patients were observed with frequent controls to assess the need of ICU in case of deterioration. The aim was mainly to offload the ICU.
Results
We studied 41 patients who were admitted for getting HFNO treatment either as primary treatment (Step-Up) or after stabilizing in the ICU (Step-Down). We studied the patients’ characteristics and the treatment’s result and compared it to a subgroup of patients who did not survive this treatment. Most of our patients were men (80%). They had at least one chronic disease (61%). Each patient had on average 5.6 days of treatment with HFNO. 55% of the patients were discharged home or to geriatric rehabilitation. 10% avoided ICU completely and 15% of patients who simultaneously had a DNR orders (Do-Not-Resuscitate) survived by using HFNO and moved to geriatric rehabilitation. The usage of HFNO saved in total 229 days in the ICU. Mortality was higher among elderly patients, and patients with comorbidities (mainly hypertension and obesity).
Discussion and conclusion
HFNO treatment is feasible and efficient for patients with Covid-19, saving resources in ICU when the need is maximized, and offering additional advantages as waken proning and fewer complications compared to traditional ICU care. It requires however frequent controls as deterioration is recurrent.
Keywords
High-flow nasal oxygen, Covid-19, ICU, ARDS
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This is a preprint. It has not completed peer review.
Research
issa issa
Sodersjukhuset AB
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 12 Mar, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction
The usage of high-flow nasal oxygen (HFNO) has traditionally been located in intensive care units (ICU). As the Covid-19 pandemic continues to be a challenge to the whole world, health care providers are trying to manage space in the ICU. HFNO is well studied for usage in acute respiratory distress syndrome (ARDS). We tried to study the usage of HFNO in patients with moderate to severe ARDS related to Covid-19 outside the ICU as well as its benefits both for patients and to offload the ICU.
Methods
We started a project to use HFNO in the ward of infectious diseases at Södersjukhuset, Stockholm. Patients with Covid-19 who needed HFNO were transferred to this ward after assessment from anesthesiologists or intensive care doctors. The patients were observed with frequent controls to assess the need of ICU in case of deterioration. The aim was mainly to offload the ICU.
Results
We studied 41 patients who were admitted for getting HFNO treatment either as primary treatment (Step-Up) or after stabilizing in the ICU (Step-Down). We studied the patients’ characteristics and the treatment’s result and compared it to a subgroup of patients who did not survive this treatment. Most of our patients were men (80%). They had at least one chronic disease (61%). Each patient had on average 5.6 days of treatment with HFNO. 55% of the patients were discharged home or to geriatric rehabilitation. 10% avoided ICU completely and 15% of patients who simultaneously had a DNR orders (Do-Not-Resuscitate) survived by using HFNO and moved to geriatric rehabilitation. The usage of HFNO saved in total 229 days in the ICU. Mortality was higher among elderly patients, and patients with comorbidities (mainly hypertension and obesity).
Discussion and conclusion
HFNO treatment is feasible and efficient for patients with Covid-19, saving resources in ICU when the need is maximized, and offering additional advantages as waken proning and fewer complications compared to traditional ICU care. It requires however frequent controls as deterioration is recurrent.
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