HealthResJ, health, medicine, nursing, research

Use of high-flow nasal cannula in patients with COVID-19: A retrospective study

Published: Jan 6, 2023
COVID-19 high-flow nasal cannula oxygen therapy respiratory support Acute Respiratory Failure (ARF)
Ioannis Tsolakoglou
Agni Sakkou
Alexandros Giannoulakis
Pantelis Stergiannis
Eleytheria Karathanasi
George Intas


Background: During COVID-19 pandemia, the healthcare systems all over the world had to confront many different and complicated issues. One of them was the way to support the patients’ respiratory system. Generally, the HFNC therapy was applied in the past for respiratory support, but we did not have studies to establish its efficiency. Therefore, with the recent study, despite the small number of patients, an effort was made to apply the HFNC therapy so as to avoid intubation and invasive mechanical ventilation.

Methods: This current study is a retrospective. Patients’ medical data admitted in the Covid – 19 ward from Agios Pavlos General hospital in Thessaloniki from October 25, 2020 to May 25, 2021 were reviewed. General clinical outcomes, the success of HFNC therapy, and related respiratory support methods were evaluated.

Results: The present study included 39 patients (27 men and 12 women), whose mean age was 64,5±10,3 years old, 44% of the population had a clear medical history, and 56,4% had some comorbidities. After applying HFNC therapy, 66,7% withdrew successfully, and 33,3% were intubated. The mean time of HFNC therapy is 3,3±2,4 days, while the mean total length of hospitalization was 18,3±10,9.

Conclusions: This current study describes the application of HFNC during the COVID-19 pandemia, and the conclusion is that the use of HFNC is an effective way to treat COVID-19 infected patients but under close monitoring. It had been shown that the application of HFNC can reduce the rate of intubation and mortality. Nevertheless, the conclusions of this particular study cannot be generalized.

Article Details
  • Section
  • Research Articles
Download data is not yet available.
Date last updated: October 7 2021. Date last accessed: October 7 2021
Hu M, Qiang Z, Ruiqiang Z, et al. Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. BMC Pulm Med 2020;20:324.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223)497-506.
Di Lecce V, Carpagnano GE, Pierucci P, et al. Baseline characteristics and outcomes of COVID -19) patients ad-mitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy. Multidisciplinary Respiratory Medicine 2020; 15:704.
Patel M, Gangemi A, Marron R, et al. Retroprospective analysis of high flow nasal therapy in COVID-19 – related moderate-to-severe hypoxaemic respiratory failure. BMJ Open Resp Res 2020; 7:e000650.
Grasseli G, Zangrillo A, Zanella A, et al. Baseline character-istics and outcomes of 1591 patients infected withSARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 2020. doi:10.1001/jama.2020.5394.
Rello J, Perez M, Roca O, et al. High-Flow nasal therapy in adults with severe acute respiratory infection: a cohort study in patients with 2009 influenza A/H1N1v. J Crit Care 2012;27:434-9.
Ou X, Hua Y, Liu J, et al. Effect of high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respirato-ry failure: a meta-analysis of randomized controlled trials. CMAJ 2017;189:E260-7.
Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med 2019;45:563-72.
Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fi-brosis: evidence-based guidelines for diagnosis and man-agement/ Am J Respir Crit Care Med. 2011;183(6):788-824.
Roca O, Riera J Torres F, et al. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55(4):408-13.
Roca O, de Acilu MG, Caralt B, et al. Humified high flow nasal cannula supportive therapy improves outcomes in lung transplant recipients readmitted to the intensive care unit because of acute respiratory failure. Transplan-tation 2015;99(5):1092-8.
Kang BJ, Koh Y, Lim C-M, et al. Failure of high-flow nasal can-nula therapy may delay intubation and increase mor-tality. Intensive Care Med.2015;41(4):623-32.
Namendys-Silva SA. Respiratory support for patients with COVID-19 Infection. Lancet Respir Med 2020;8:e18.
Yu C. Correspondance. Br J Surg 2019;106:949.
Kluge S, Janssens U, Welte T, et al. German recommenda-tions for critically ill patients with COVID-19. Med Klin In-tensivmed Notfmed 2020;2.
NIH. COVID-19 Treatment Guidelines. Clinical spectrum of SaRS-CoV-2 infection.
CDC. Interim clinical guidance for management of pa-tients with confirmed Coronovirus Disease(COVID-19).
Date last updated: Feb. 16, 21 Date last assessed: Oct. 15, 21
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. 2020 Jun;395:1054–62. icon
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation pa-rameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020 February 19;18(4). doi:10.1111/jth.14768external icon.
American Venous Forum. Considerations in prophylaxis and treatment of VTE in COVID-19 Patients. 2020. Ac-cessed April 2020 at icon.
Klok, FA; Kruip, MJHA; van der Meer NJM et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020 Jul;191:145–7. doi:10.1016/j.thromres.2020.04.013external icon.
Helms, J; Tacquard, C; Severac, F et al. High risk of throm-bosis in patients in severe SARS-CoV-2 infection: a multi-center prospective cohort study. Intensive Care Medicine. 2020 May 4;46(6):1089–8. doi:10.1007/s00134-020-06062-xexternal icon
Grillet, F; Behr, J; Calame, H et al. Acute Pulmonary Embo-lism Associated with COVID-19 Pneumonia Detected by Pulmonary CT Angiography. Radiology 2020. April 23;296(3):E186–E188. doi:10.1148/radiol.2020201544external icon.
Oxley, T; Mocco, J; Majidi,S et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020 April 28;382:e60. doi:10.1056/NEJMc2009787external icon.
Li, Y; Wang, M; Zhou, Y et al. Acute Cerebrovascular Dis-ease Following COVID-19: A Single Center, Retrospective, Observational Study. Stroke Vasc Neurol. 2020 July 2;5(3):e000431. doi:10.1136/svn-2020-000431external icon.
Margo,C; Mulvey, J; Berlin, D et al. Complement associat-ed microvascular injury and thrombosis in the pathogen-esis of severe COVID-19 infection: A report of five cas-es. Translational Research. 2020;220:1–13. doi:10.1016/j.trsl.2020.04.007external icon.
Merad, M., Martin, J.C. Pathological inflammation in pa-tients with COVID-19: a key role for monocytes and mac-rophages. Nat Rev Immunol. 2020;20:355–62. doi:10.1038/s41577-020-0331-4external icon.
WHO/2019-nCoV/clinical/2021.1. Clinical Management of COVID-19: living guidance
Spinelli E, Roca O, Mauri T. Dynamic assessment of the ROX index during nasal high flow for early identification of non-responders. J Crit Care. 2019. doi:
Karim HMR, Zaccgnini M, Esquinas AM. Acute increase in nasal high flow supports ROX index stability: Our insights in response to Mauri T et al. JCrit Care.2019. doi:
Date last updated: April 21, 2021. Date last assessed: Oc-tober 13, 2021.
Wang D, Hu B, Zhu F, et al. Clinical characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia In Wuhan, China. JAMA. Doi:
Aggarwal S, Carcia-Telles N, Aggarwal G, et al. Clinical features laboratory characteristics, and outcomes of pa-tients hospitalized with Coronavirus Disease 2019 (COVID-19). Early report from the United States. Diagnosis (Berl) 2020;7:91-6.
Fu L, Wang B, Yuan T, et al.Clinical characteristics of Coro-navirus Disease 2019 (COVID-19) in China: A systemic re-view and meta-analysis. J Infect 2020;80:656-665.
Wang F, Hou H, Luo Y, et al. The laboratory tests and host immunity of COVID-19 patients with different severity of illness. JCI Insight 2020; 5:e137799.
Most read articles by the same author(s)