Feasibility of Non-Rebreather Masks and Nasal Cannula as a Substitute for High Flow Nasal Oxygen in Patients with Severe COVID-19 Infection

Mehmet Kabak, Bariş Çil

Mardin State Hospital, Department of Chest Disease, Mardin, Turkey 

Objective: Severe pneumonia and respiratory failure may develop in patients with  coronavirus (COVID-19) infection, placing a very significant burden on healthcare systems due to the need for both emergency and intensive care treatment. Therefore, treatment of hypoxemia is a clinical priority in the treatment of such patients. In this regard, new strategies such as High Flow Nasal Oxygen (HFNO) and Non-Rebreather Masks and Nasal Cannula (NRMs+NC) that can provide non-invasive high fraction of inspired oxygen are gaining clinical significance. 

Our objective was to compare oxygen supply by HFNO with NRMs + NC in terms of treatment costs and mortality in a group of COVID-19 patients requiring intensive care unit admission. 

Material and methods: This was a retrospective and single-center study involving 54 patients who were admitted to an Intensive Care Unit with a diagnosis of COVID-19 infection between July 2020 and August 2020. 

Results: HFNO was compared with NMRs + NC in terms of mortality and duration of hospital stay.  The two groups were comparable in age (p=0.45), gender (p=0.33), and mortality (p=0.43). Also, there was no significant difference in oxygen saturation at admission (p=0.63), duration of intensive care (p=0.35), total length of hospital stay (p=0.057), and need for invasive mechanical ventilator (p=0.39) between the study groups. 

The levels of WBC (p=0.36), platelets (p=0.12), lymphocytes (p=0.98), CRP (p=0.11), pro-calcitonin (p=0.20), D-dimer (p=0.74), ferritin (p=0.14), urea (p=0.74), and creatinine (p=0.35) were also similar between the two groups.  

Conclusion: Oxygen support by NRMs + NC was comparable to HFNO in terms of mortality, need for invasive mechanic ventilation, length of intensive care, and length of hospital stay. We believe that NRMs + NC may represent an inexpensive and easily accessible therapeutic substitute for HFNO, particularly when the risk of transmission and costs related with HFNO use are considered.