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      The value of high‐flow nasal cannula oxygen therapy in treating novel coronavirus pneumonia

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          Abstract

          Objective

          This study aimed to investigate the value of high‐flow nasal cannula (HNFC) oxygen therapy in treating patients with severe novel coronavirus pneumonia (COVID‐19).

          Methods

          The clinical data of 22 patients with severe COVID‐19 were collected. The heart rate (HR), respiratory rate (RR) and oxygenation index (PO 2/FiO 2) at 0, 6, 24 and 72 hours after treatment were compared between the HFNC oxygen therapy group and the conventional oxygen therapy (COT) group. In addition, the white blood cell (WBC) count, lymphocyte (L) count, C‐reactive protein (CRP) and procalcitonin (PCT) were compared before and at 72 hours after oxygen therapy treatment.

          Results

          The differences at 0 hours between the two groups were not statistically significant. Compared with COT group,in the HFNC oxygen therapy group, HR, RR and PaO 2/FiO 2 were better at 6 hours after treatment, PaO 2/FiO 2 was better at 24 and 72 hours. After 72 hours, L and CRP had improved in the HFNC oxygen therapy group compared with the COT group, but the differences in WBC and PCT were not statistically significant. The length of stay in the intensive care unit (ICU) and the total length of hospitalization was shorter in the HFNC oxygen therapy group than in the COT group.

          Conclusion

          Compared with COT, early application of HFNC oxygen therapy in patients with severe COVID‐19 can improve oxygenation and RR, and HFNC oxygen therapy can improve the infection indexes of patients and reduce the length of stay in the ICU of patients. Therefore, it has high clinical application value.

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          Most cited references13

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          High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure.

          Jean-Pierre Frat, Arnaud W Thille, Alain Mercat … (2015)
          Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia.
          Article 0 comments Cited 471 times – based on 0 reviews     Review now
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            Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients.

            A Corley, L.R. Caruana, A.G. Barnett … (2011)
            High-flow nasal cannulae (HFNCs) create positive oropharyngeal airway pressure, but it is unclear how their use affects lung volume. Electrical impedance tomography allows the assessment of changes in lung volume by measuring changes in lung impedance. Primary objectives were to investigate the effects of HFNC on airway pressure (P(aw)) and end-expiratory lung volume (EELV) and to identify any correlation between the two. Secondary objectives were to investigate the effects of HFNC on respiratory rate, dyspnoea, tidal volume, and oxygenation; and the interaction between BMI and EELV. Twenty patients prescribed HFNC post-cardiac surgery were investigated. Impedance measures, P(aw), ratio, respiratory rate, and modified Borg scores were recorded first on low-flow oxygen and then on HFNC. A strong and significant correlation existed between P(aw) and end-expiratory lung impedance (EELI) (r=0.7, P<0.001). Compared with low-flow oxygen, HFNC significantly increased EELI by 25.6% [95% confidence interval (CI) 24.3, 26.9] and P(aw) by 3.0 cm H(2)O (95% CI 2.4, 3.7). Respiratory rate reduced by 3.4 bpm (95% CI 1.7, 5.2) with HFNC use, tidal impedance variation increased by 10.5% (95% CI 6.1, 18.3), and ratio improved by 30.6 mm Hg (95% CI 17.9, 43.3). A trend towards HFNC improving subjective dyspnoea scoring (P=0.023) was found. Increases in EELI were significantly influenced by BMI, with larger increases associated with higher BMIs (P<0.001). This study suggests that HFNCs reduce respiratory rate and improve oxygenation by increasing both EELV and tidal volume and are most beneficial in patients with higher BMIs.
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              Research in high flow therapy: mechanisms of action.

              Kevin Dysart, Thomas L. Miller, Marla Wolfson … (2009)
              Recently, heater/humidifier devices that use novel methods to condition breathing gases from an external source have been introduced. The addition of sufficient warmth and high levels of humidification to breathing gas has allowed for higher flow rates from nasal cannula devices to be applied to patients (i.e., high flow therapy). This article provides a review of the proposed mechanisms behind the efficacy of high flow therapy via nasal cannula, which include washout of nasopharyngeal dead space, attenuation of the inspiratory resistance associated with the nasopharynx, improvement in conductance and pulmonary compliance, mild distending pressure and reduction in energy expenditure for gas conditioning.
              Article 0 comments Cited 90 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ming‐feng Han:
                ORCID: https://orcid.org/0000-0001-8091-2285
                hanmingf_eng@163.com
                Journal
                Journal ID (nlm-ta): Eur J Clin Invest
                Journal ID (iso-abbrev): Eur J Clin Invest
                Journal ID (doi): 10.1111/(ISSN)1365-2362
                Journal ID (publisher-id): ECI
                Title: European Journal of Clinical Investigation
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0014-2972
                ISSN (Electronic): 1365-2362
                Publication date (Electronic): 31 October 2020
                Electronic Location Identifier: e13435
                Affiliations
                [ 1 ] Department of Respiratory and Critical Care Medicine No. 2 People's Hospital of Fuyang City Fuyang China
                [ 2 ] Department of Respiratory and Critical Care Medicine No. 2 People's Hospital of Wuhu City Wuhu Anhui China
                Author notes
                [*] [* ] Correspondence

                Ming‐feng Han, Department of Respiratory and Critical Care Medicine,N0. 2 People's Hospital of Fuyang City, No. 1088 of Yinghexi Road, Yingzhou District, Fuyang, Anhui, 236000, China.

                Eamil: hanmingf_eng@ 123456163.com

                Author information
                https://orcid.org/0000-0001-8091-2285
                Article
                Publisher ID: ECI13435
                DOI: 10.1111/eci.13435
                PMC ID: 7645937
                PubMed ID: 33068293
                SO-VID: 5c41e35d-d240-4233-a205-c575f8e434d5
                Copyright © © 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date received : 23 July 2020
                Date revision received : 13 October 2020
                Date accepted : 14 October 2020
                Page count
                Figures: 2, Tables: 6, Pages: 6, Words: 7271
                Funding
                Funded by: The second batch of COVID‐19 emergency science and technology project in Fuyang city
                Award ID: FK20202802
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.3 mode:remove_FC converted:06.11.2020

                ScienceOpen disciplines: Medicine
                Keywords: coronavirus disease 2019,high nasal flow oxygen therapy,pneumonia
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: coronavirus disease 2019, high nasal flow oxygen therapy, pneumonia

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