High-flow Nasal Cannula therapy: A feasible treatment for vulnerable elderly COVID-19 patients in the wards

Job van Steenkiste*, Michael C. van Herwerden, Dolf Weller, Christiaan J. van den Bout, Rikje Ruiter, Jan G. den Hollander, Rachida el Moussaoui, Gert T. Verhoeven, Charlotte van Noord, Marinus A. van den Dorpel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)


Background: Invasive mechanical ventilation is the treatment of choice in COVID-19 patients when hypoxemia persists, despite maximum conventional oxygen administration. Some frail patients with severe hypoxemic respiratory failure are deemed not eligible for invasive mechanical ventilation. Objectives: To investigate whether High-flow nasal cannula (HFNC) in the wards could serve as a rescue therapy in these frail patients. Methods: This retrospective cohort study included frail COVID-19 patients admitted to the hospital between March 9th and May 1st 2020. HFNC therapy was started in the wards. The primary endpoint was the survival rate at hospital discharge. Results: Thirty-two patients with a median age of 79.0 years (74.5–83.0) and a Clinical Frailty Score of 4 out of 9 (3–6) were included. Only 6% reported HFNC tolerability issues. The overall survival rate was 25% at hospital discharge. Conclusions: This study suggests that, when preferred, HFNC in the wards could be a potential rescue therapy for respiratory failure in vulnerable COVID-19 patients.

Original languageEnglish
Pages (from-to)654-659
Number of pages6
JournalHeart and Lung
Issue number5
Publication statusPublished - 1 Sept 2021

Bibliographical note

Funding Information:
This study was approved by the Hospitals Medical Ethical Committee (Medical Research Ethics Committees United, reference L2019023), application number W20.081. The datasets that were used and/or analysed during the current study, are available from the corresponding author by a reasonable request. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. JS and MvH invented the study and were responsible for the integrity of the database. All authors were responsible for the treatment of patients, collecting clinical and additional data and for writing the manuscript. All authors approved the final version after reviewing, We thank Geeke van Waverijn for data extraction and preparation. We thank Evelien Oostdijk and Rob Zwinkels for the critical reading of the manuscript.

Publisher Copyright:
© 2021 Elsevier Inc.


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