What is the role of oxygen delivery devices in the treatment of coronavirus disease 2019 (COVID-19)?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Although no randomized control trial exists, the current paradigm is to support hypoxia up to a level of 92-96%. Several options for oxygen delivery exist. These can include a simple nasal cannula, which can provide up to 6 L or approximately 44% FiO2. Further oxygen demand can be met by a nonrebreather mask, which can increase flow to 6-10 L while providing 100% FiO2.

Currently, the use of noninvasive ventilation in COVID-19 patients is under intense debate. High-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NIPPV) have become standards of care in the ICU for patients with hypoxic respiratory failure and are known to help prevent endotracheal intubation. However, in COVID-19, the risk of intubation needs to be balanced against the potential risk of aerosolization of the virus and potentially increasing the exposure to healthcare workers. Currently, no guidelines exist to guide management in these patients; however, an initial report from Hong Kong recommended against the use of HFNC and NIPPV in COVID-19 patients. [21] A retrospective review from China examined a small cohort of 27 patients who developed severe acute respiratory failure after being diagnosed with COVID-19. [22] Of these, 63% were initially treated with HFNC. Interestingly, 41% of those treated with HFNC (n=7) developed further respiratory failure necessitating NIPPV and even intubation. Some indicators for HFNC included a PaO2/FiO2 ratio of less than 200 mm Hg and worsening tachypnea. [22] The Society of Critical Care Medicine (SCCM) suggests the use of HFNC over NIPPV (weak strength). Similarly, the SCCM also suggests using NIPPV with close monitoring, if HFNC is not available and the patient is not in emergent need of intubation (weak strength). [23]


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