Open AccessThe Impact of High-Flow Nasal Cannula Use on Patient Mortality and the Availability of Mechanical Ventilators in COVID-19
Author(s) -
Hayley B. Gershengorn,
Yue Hu,
Jen Ting Chen,
SzuChuan Hsieh,
Jing Dong,
Michelle N. Gong,
Carri W. Chan
Publication year - 2021
Publication title -
annals of the american thoracic society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.035
H-Index - 114
eISSN - 2329-6933
pISSN - 2325-6621
DOI - 10.1513/annalsats.202007-803oc
Subject(s) - nasal cannula , medicine , cannula , mechanical ventilation , mechanical ventilator , population , covid-19 , intubation , intensive care medicine , ventilation (architecture) , anesthesia , emergency medicine , surgery , disease , infectious disease (medical specialty) , mechanical engineering , environmental health , engineering
Rationale: How to provide advanced respiratory support for coronavirus disease (COVID-19) to maximize population-level survival while optimizing mechanical ventilator access is unknown. Objectives: To evaluate the use of high-flow nasal cannula for COVID-19 on population-level mortality and ventilator availability. Methods: We constructed dynamical (deterministic) simulation models of high-flow nasal cannula and mechanical ventilation use for COVID-19 in the United States. Model parameters were estimated through consensus based on published literature, local data, and experience. We had the following two outcomes: 1 ) cumulative number of deaths and 2 ) days without any available ventilators. We assessed the impact of various policies for the use of high-flow nasal cannula (with or without "early intubation") versus a scenario in which high-flow nasal cannula was unavailable. Results: The policy associated with the fewest deaths and the least time without available ventilators combined the use of high-flow nasal cannula for patients not urgently needing ventilators with the use of early mechanical ventilation for these patients when at least 10% of ventilator supply was not in use. At the national level, this strategy resulted in 10,000-40,000 fewer deaths than if high-flow nasal cannula were not available. In addition, with moderate national ventilator capacity (30,000-45,000 ventilators), this strategy led to up to 25 (11.8%) fewer days without available ventilators. For a 250-bed hospital with 100 mechanical ventilators, the availability of 13, 20, or 33 high-flow nasal cannulas prevented 81, 102, and 130 deaths, respectively. Conclusions: The use of high-flow nasal cannula coupled with early mechanical ventilation when supply is sufficient results in fewer deaths and greater ventilator availability.