When is the right time for nasal high flow therapy?

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When is the right time for nasal high flow therapy?

January 22, 2021
Emergency Medicine
Chris Hutchinson
By Chris Hutchinson

As the United States enters yet another surge of the coronavirus with more than 21 million cases nationwide and growing, healthcare professionals are bracing for a shortage of ventilators and overcrowded ICU spaces. Even the recent announcements regarding the issuance of vaccines cannot relieve the scarcity in the short-term, leaving healthcare professionals in search of relief in a quick time frame.

The good news for medical personnel is that for Covid-19 patients who have severe respiratory symptoms, there are alternative therapies to classic ventilation, including newer, non-invasive approaches which could help offset the demand for ventilators, improve patient outcomes and preserve hospital resources. Officials at two major medical centers in the U.S. learned this past year that acute coronavirus patients had positive outcomes after receiving Nasal High Flow Therapy (NHF Therapy). Healthcare workers from these medical centers, which include UnityPoint in Des Moines, Iowa and Temple University in Philadelphia, report that utilizing NHF Therapy meant a host of benefits for their patients and frontline healthcare workers that included shorter treatment time with decreased chance of going into the ICU; no increased risks of aerosolization or harm to frontline healthcare workers; and a more comfortable and non-invasive therapy, leading to a faster recuperation for patients.

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Most importantly, patient mortality rates declined with use of NHF Therapy.

Mechanical ventilation is risky for COVID-19 patients
A major reason to keep patients off mechanical ventilation is that the process poses many risks to weak patients. According to JAMA, “early series suggested high mortality for patients with Covid-19–associated respiratory failure who received invasive mechanical ventilatory support, raising the concern that these patients may be particularly vulnerable to ventilator-induced lung injury.”

A key differentiation lies in the fact that classic ventilation intubation is an invasive procedure that requires the patient to be anesthetized, which can be a perilous proposition.

What is nasal high flow therapy and why does it work?
NHF Therapy is a non-invasive approach that allows oxygen to be delivered to patients at very high flow rates via a heated and humidified nasal cannula system at a prescribed fraction of inspired oxygen (FIO2) levels. Flow rates have been studied as high as 60L/minute depending on the patient interface and the facility’s oxygen delivery source. These systems can be used with a variety of patient interfaces, including a nasal interface that covers the nostrils, leaving the mouth unobstructed, allowing the patient to eat, drink and speak.

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