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.

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.

Patient tolerance and comfort are greatly enhanced due to the high-flow nasal cannula oxygen system’s ability to heat and humidify. A recent study in RESPIRATORY CARE in 2020, showcased that utilizing NHF Therapy kept more than half of the participating subjects out of the ICU and indicated that patients with acute hypoxic respiratory failure can safely receive NHF Therapy with successful outcomes.

UnityPoint Health keeps 73% of COVID-19 patients off ventilation using NHF therapy
UnityPoint Health found that Covid-19 patients on ventilators stayed in the ICU between eight and 14 days and took much longer to recover and breathe on their own. However, when the hospital administered NHF Therapy, the ICU stay averaged only three days.

By utilizing NHF Therapy for its Covid-19 patients, the medical staff successfully kept 73 percent of the patients off invasive ventilation.

Temple University Hospital prevents COVID-19 patients from being admitted to the ICU
Temple University Hospital in Philadelphia was inundated with nearly 500 Covid-19 patients in need of possible ventilation in March 2020. Given the high risk of mortality associated with Covid-19 patients and ventilation, the doctors looked for alternative therapies. Of the 500, approximately 104 patients were given NHF Therapy from March 10 to April 24 with positive results. The NHF Therapy prevented the need to intubate 67 of 104 patients (64.42 percent).

In addition, healthcare workers remained safe and unharmed – not one person developed the Covid-19 virus.

Not every COVID-19 patient requires ventilation or the ICU
There is no question that a possible ventilator shortage along with reduced ICU capacity can be a distressing outcome of this fast-spreading disease, but here are some facts that may put these statistics in perspective: not every Covid-19 patient requires the ICU and not every patient needs to be escalated to ventilation. In fact, according to the Center for Disease Control or CDC, approximately 20-30 percent of Covid-19 patients require hospitalization and a smaller number of those patients, 5 to 10 percent, necessitate the level of treatment that would require a stay in the ICU.

With the next, and perhaps most severe, wave of the outbreak upon us, now is the time for the medical community to look at all its options for severely ill Covid-19 patients. Both Temple University and UnityPoint were able to reap numerous positive results when administering NHF Therapy, proving the concept in an earlier wave of the outbreak.

Now is the time to put those lessons into action.

While ventilators will certainly be an important weapon against Covid-19, there are additional therapies available in the fight against the pandemic with increased benefits, including shorter stays in the ICU and lower mortality rates. Nasal High Flow Therapy has proven not only to be a safe and effective treatment, but also increases the functional capacity of the hospital, which is a direct benefit to any community.

About the author: Chris Hutchinson is the director of clinical affairs at Fisher & Paykel Healthcare.