The Use of High-Flow Nasal Cannula and Non-Invasive Mechanical Ventilation in the Management of COVID-19 Patients: A Prospective Study
Sumalatha Arunachala,
Ashwaghosha Parthasarathi,
Chetak Kadabasal Basavaraj,
Sowmya Malamardi,
Shreya Chandran,
Hariharan Venkataraman,
Mohammed Kaleem Ullah,
Koustav Ganguly,
Swapna Upadhyay,
Padukudru Anand Mahesh
Affiliations
Sumalatha Arunachala
Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India
Ashwaghosha Parthasarathi
Allergy, Asthma, and Chest Centre, Krishnamurthy Puram, Mysuru 570004, India
Chetak Kadabasal Basavaraj
Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India
Sowmya Malamardi
Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India
Shreya Chandran
Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India
Hariharan Venkataraman
Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India
Mohammed Kaleem Ullah
Centre for Excellence in Molecular Biology and Regenerative Medicine (A DST-FIST Supported Center), Department of Biochemistry (A DST-FIST Supported Department), JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India
Koustav Ganguly
Unit of Integrative Toxicology, Institute of Environmental Medicine (IMM), Karolinska Institute, 17177 Stockholm, Sweden
Swapna Upadhyay
Unit of Integrative Toxicology, Institute of Environmental Medicine (IMM), Karolinska Institute, 17177 Stockholm, Sweden
Padukudru Anand Mahesh
Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India
High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, especially in low- and middle-income countries (LMICs), due to lack of ventilators and manpower resources despite the paucity of data regarding their efficacy. This prospective study aimed to analyse the efficacy of HFNC versus NIV in the management of COVID-19 ARDS. A total of 88 RT-PCR-confirmed COVID-19 patients with moderate ARDS were recruited. Linear regression and generalized estimating equations (GEEs) were used for trends in vital parameters over time. A total of 37 patients were on HFNC, and 51 were on NIV. Patients in the HFNC group stayed slightly but not significantly longer in the ICU as compared to their NIV counterparts (HFNC vs. NIV: 8.00 (4.0–12.0) days vs. 7.00 (2.0–12.0) days; p = 0.055). Intubation rates, complications, and mortality were similar in both groups. The switch to HFNC from NIV was 5.8%, while 37.8% required a switch to NIV from HFNC. The resolution of respiratory alkalosis was better with NIV. We conclude that in patients with COVID-19 pneumonia with moderate ARDS, the duration of treatment in the ICU, intubation rate, and mortality did not differ significantly with the use of HFNC or NIV for respiratory support.
