High Flow Devices Can Free Up Resources During COVID Surges
The pandemic is not over in the US, and it is much further from being over for the rest of the world. There are signals that parts of the US are in for another tough winter. The spikes in unvaccinated areas are particularly alarming; Mississippi, Arkansas, Texas and Florida are notable states where resources are beginning to thin.
TIGHT RESOURCES: The argument for using noninvasive high flow devices as a frontline therapy has gotten much clearer in the past year, particularly in areas with tight resources. High flow devices tend to be cheaper, use less resources, and are more flexible in their deployment than more invasive mechanical ventilators. You can send a patient home with a high flow device, but not a mechanical ventilator.
AEROSOLIZATION CONCERNS: Well into 2020 many clinicians debated the risks of recommending using high flow devices in COVID-19 wards. This was due to concerns of aerosolization as well as questioning the quality of available clinical evidence for using this kind of device 1,2,3,4,5,6,7. The thought was a device blowing air into an infected patient’s lungs would also blow more of the virus into the surrounding area than normal coughing would, increasing the chances of contaminating clinical staff.
DISPUTED CONCERNS IN PRACTICE: Early rebuttals disputed the idea of aerosolizing the virus to the point of endangering staff further than just working in a COVID-19 ward. Early recommendations in favor of high-flow device use came with a strong recommendation that staff be well protected with PPE if used within the hospital setting 8,9. Evidence gathered in the past year has demonstrated that transmission rates were not higher in clinical practice 3,9,15,19.
HIGH FLOW USE IN PRACTICE: Beyond studying transmission to staff, there has been quite a bit of research on where high-flow devices could fit into the treatment regimen. Several studies and one meta-analysis provide evidence that noninvasive high-flow devices can be used as a frontline therapy for up-to mild COVID-19 ARDS instead of resource-heavy invasive treatments using mechanical ventilators as well as weaning patients off of mechanical ventilation 10,11,12,13,14,15,16,17,18.
LOW RESOURCE DEPLOYMENT & MASKS: A running theme for every walk of life this past year was to reduce the airborne transmission of the COVID-19 virus by wearing masks. There is quite a bit of positive evidence supporting the use of high flow treatments for COVID patients, particularly in resource-strained areas, and with an updated recommendation to just cover the patient’s airway with something as light as a surgical mask 9,12,14,17,18,20,21,22,23,24,25.
CONCLUSION: If we used less invasive high-flow devices we would be able to free up clinical space and resources for higher-need patients during COVID surges.
REFERENCES: Google Doc Link.
