Clinical observation of high-flow nasal cannula (HFNC) with non-rebreather mask (NRM) use on severe or critically ill COVID-19 diabetic patients

Objective: Diabetes prevalence is a vital factor in COVID-19's clinical prognosis. This study aimed to investigate and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without non-rebreather mask (NRM) on critical COVID-19 patients with/without diabetes. Materials and methods: For analysis and comparison, epidemiological, biochemical, and clinical data were collected from 240 HFNC±NRM treated severe and critical COVID-19 ICU patients (diabetic = 136; non-diabetic = 104) of five hospitals in Chattogram, Bangladesh. Results and Discussion: 59.1% patients with fever had diabetes (p=0.012). ICU stay was longer for diabetic patients (9.06±5.70) than non-diabetic ones (7.41±5.11) (p=0.020). Majority of hypertensive patients were diabetic (68.3%; p<0.001). Most of the diabetic patients (70.4%; p<0.005) had elevated creatinine levels. The partial pressure of oxygen after HFNC (only) was significantly (p=0.031) higher in non-diabetic patients (69.30±23.56) than diabetic ones (61.50±14.49). Diabetic (62.64±13.05) and non-diabetic patients (59.40±13.22) had similar partial pressure of oxygen from HFNC+NRM. Majority of the diabetic patients who required HFNC+NRM had elevated RBS (73.8%; p=0.001) and creatinine (75.7%; p=0.009). Factors affecting the HFNC only treated patients were fever and impaired glucose tolerance. Besides, increased plasma glucose level, age, and hypertension affected the HFNC + NRM treated diabetic patients. Conclusion: The results of this study imply that oxygen supply with HFNC+NRM may be beneficial for the elderly/hypertensive diabetic patients with COVID-19 associated AHRF; and that IGT and increased blood glucose levels could be determinants for COVID-19 severity. However, further experiments to substantiate these claims are required on a larger sample and among different clinical cohorts.

Download Full-text

High-flow nasal cannula therapy, factors affecting effective inspired oxygen fraction: an experimental adult bench model

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-021-00784-z ◽

2021 ◽

Author(s):

Frédéric Duprez ◽

C. de Terwangne ◽

V. Bellemans ◽

W. Poncin ◽

G. Reychler ◽

...

Keyword(s):

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Factors Affecting ◽

Oxygen Fraction ◽

Inspired Oxygen ◽

Bench Model

Download Full-text

Factors affecting FiO 2 and PEEP during high‐flow nasal cannula oxygen therapy: A bench study

The Clinical Respiratory Journal ◽

10.1111/crj.13087 ◽

2019 ◽

Vol 13 (12) ◽

pp. 758-764 ◽

Cited By ~ 1

Author(s):

Yu‐Han Sun ◽

Bing Dai ◽

Yun Peng ◽

Wei Tan ◽

Hong‐Wen Zhao

Keyword(s):

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Factors Affecting ◽

Bench Study

Download Full-text

High-flow nasal cannula for reducing hypoxemic events in patients undergoing bronchoscopy: A systematic review and meta-analysis of randomized trials

PLoS ONE ◽

10.1371/journal.pone.0260716 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260716

Author(s):

Chien-Ling Su ◽

Ling-Ling Chiang ◽

Ka-Wai Tam ◽

Tzu-Tao Chen ◽

Ming-Chi Hu

Keyword(s):

Systematic Review ◽

Partial Pressure ◽

Oxygen Therapy ◽

Therapy Group ◽

Weighted Mean Difference ◽

Meta Analysis ◽

High Flow ◽

Nasal Cannula ◽

Cochrane Library ◽

High Flow Nasal Cannula

Background Patients undergoing bronchoscopic procedures may develop hypoxemia and severe complications. High-flow nasal cannula (HFNC) may prevent hypoxemic events during bronchoscopy. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of HFNC in these patients. Methods We conducted a search in PubMed, Embase, and the Cochrane Library for RCTs published before November 2021. Individual effect sizes were standardized, and a meta-analysis was performed to calculate the pooled effect size using random-effects models. The primary outcome was the incidence of hypoxemic events (oxygen saturation [SpO2] < 90%) during bronchoscopy. Secondary outcomes included the incidence of interrupted bronchoscopy due to desaturation, lowest SpO2 during bronchoscopy, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), end-tidal CO2 (EtCO2) at the end of bronchoscopy, and the incidence of intubation after the procedure. Results Five trials involving 257 patients were reviewed. The incidence of hypoxemic events was lower in the HFNC group than in the conventional oxygen therapy group (risk ratio, 0.25; 95% confidence interval [CI], 0.14–0.42). The lowest SpO2 during the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (weighted mean difference [WMD], 7.12; 95% CI, 5.39–8.84). PaO2 at the end of the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (WMD, 20.36; 95% CI, 0.30–40.42). The incidence of interrupted bronchoscopy due to desaturation, PaCO2 and EtCO2 at the end of the procedure, and the incidence of intubation after the procedure were not significantly different between groups. Conclusions HFNC may reduce the incidence of hypoxemic events and improve oxygenation in patients undergoing bronchoscopy.

Download Full-text

Factors affecting the outcome of the usage of high-flow nasal cannula on severe or critically ill COVID-19 patients: a multicentric study from a developing nation

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v7i3.56136 ◽

2021 ◽

Vol 7 (3) ◽

pp. 260-272

Author(s):

Moumita Das ◽

Shuva Das ◽

AFM T Bhuiyan ◽

Sudipta Deb Nath ◽

Rajdeep Biswas ◽

...

Keyword(s):

Critically Ill ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Biochemical Tests ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Multicentric Study ◽

Factors Affecting ◽

Very High

In resource-constrained settings, High-Flow Nasal Cannula (HFNC) can reduce the burden on mechanical ventilation in COVID-19 induced Acute Hypoxemic Respiratory Failure (AHRF). The aim was to observe the factors those might affect the outcome of the usage of HFNC on severe/critically ill COVID-19 patients. This is a multicentric prospective observational study. We observed rRT-PCR positive severe/critically ill ICU patients requiring HFNC for more than six hours. Statistical analysis was done to correlate between factors and outcome. Weaning from HFNC was successful in 47.5% of patients. The death rate was higher in ≥ 50 years older (56.50%), and patients with asthma (60.57%), COPD (60.00%), and CKD (68.42%). Fever (91.67%), cough (72.5%), and dyspnea (67.5%) were the most common symptoms. Mortality rates were higher for patients with raised blood sugar, creatinine levels. Severely systemic inflammatory response was seen very high for the expired patients. On HFNC, percent saturation of oxygen (SpO2) and partial pressure of oxygen (PaO2) progression was significantly high for the surviving patients requiring less inspired fraction of oxygen (FiO2%). The survival rate was higher for the patients using both HFNC and non-rebreather mask (NRM) concomitantly. While after HFNC- SpO2% and FiO2% were significantly related with outcome of the HFNC only treated patients, duration of hospital stay and on HFNC- FiO2% affected the HFNC + NRM treated patients’ outcome. HFNC could save more lives of critically ill AHRF patients who otherwise might need invasive or noninvasive ventilation. Some biochemical tests were observed to have association with the prognosis of the disease though HFNC was given to all. Survival benefit of dual HFNC and NRM therapy needs future study. Asian J. Med. Biol. Res. 2021, 7 (3), 260-272

Download Full-text