The use of High-Flow Nasal Oxygen (HFNO) Therapy for severe COVID-19 cases is becoming more and more widespread. It all started when the bold doctors at Tygerberg Hospital in Cape Town implemented a gutsy, much lesser-known treatment that not only bypassed the current ventilator shortage, but possibly saved thousands of lives whilst also providing a more patient-friendly experience. But before we get in to that, let’s start from the beginning:
High Flow Nasal Oxygen is a non-invasive oxygen therapy that channels oxygen into the lungs of the patient through nasal tubes at a high flow. HFNO devices are used in hospitals, where the oxygen (usually in conjunction with compressed air and humidification) is delivered to a patient at rates of flow higher than in conventional oxygen therapy. Your traditional oxygen therapy would be up to 16 Litres/min, whereas high flow oxygen therapy is up to 60 Litres/min.
HFNO Therapy is far more ‘patient-friendly’ than conventional ventilation which requires a tube down the patient’s throat. Patients receiving HFNO Therapy are still able to eat, talk and engage with others in the ward. Although many prefer HFNO, it does not replace mechanical ventilation, which is still extensively used in the management of Covid-19 patients. The treatment of HFNO provides an extra ‘arrow’ in doctors’ quiver in the fight against Covid-19.
When the first of the Covid-19 patients with severe respiratory distress were admitted to Tygerberg Hospital’s intensive care unit (ICU) in March of 2020, the doctors treated them according to the internationally recommended treatment, which was mechanical ventilation. In line with global trends, there were high mortality rates among ventilated patients. At the time there were very little reports of HFNO being used in the treatment of COVID-19. Dr Usha Lalla, who manages the COVID-19 ICU ward in Tygerberg Hospital in Cape Town states in a comment she made on iol.co.za (Source): “I remember discussing it with colleagues, including Professor Mervin Mer from Wits University, and saying that a large proportion of the patients just need oxygen – why don’t we try it? The first patient we treated with HFNO was up and chatting on her cell phone within five days – in stark contrast to patients who have to be ventilated for two to three weeks,” said Dr Lalla. This gave the Tygerberg Hospital hope during the intense battle against the COVID-19 virus. So, they started to treat more patients with HFNO, and achieved much higher recovery rates with this new treatment method than going straight to mechanical ventilation. Of course, the news of the great success of HFNO therapy quickly spread to other hospitals in the province and later, around the country, who also rapidly adopted the method of treatment.
Utilizing High Flow Nasal Oxygen Therapy upon admission in adult patients with COVID-19 related severe respiratory failure may lead to an increase in ‘ventilator-free’ days and a reduced length of stay in the ICU, when compared to early initiation of conventional invasive mechanical ventilation.
We salute the doctors at Tygerberg Hospital for taking a leap of faith and changing the course of treatment during the COVID-19 pandemic.