High Flow Nasal Cannula Versus High Velocity Nasal Insufflation in Covid-19
Study Details
Study Description
Brief Summary
To compare the outcomes of HFNC and HVNI in COVID-19 patients with acute respiratory failure as regard need for mechanical ventilation, changes of arterial blood gases (ABG) parameters, duration of ventilatory support and delay between admission and intubation
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
novel clinical syndrome caused by a previously unknown coronavirus, SARS-Cov-2, was first identified in Wuhan (China) in December 2019. Despite massive efforts to contain viral transmission, a worldwide epidemic has developed from this virus. This disease is presently known as COVID-19 COVID-19 pandemic reached over 45 million confirmed infections and claimed the lives of more than 1.2 million people worldwide. The clinical features of COVID-19 are diverse and range from asymptomatic to critical illness and death. Severe and critical cases represented 14% and 5% of laboratory-confirmed COVID-19 patients and need ICU admission Several non-invasive options exist to support COVID-19 patients with mild or moderate respiratory distress and may reduce the numbers of patients requiring intubation, mechanical ventilation in some severely ill patients such as High flow nasal oxygen (HFNO) High flow nasal oxygen (HFNO) includes high flow nasal cannula and high velocity nasal insufflation. High flow oxygen systems provide oxygen-rich heated humidified gas to the patient's nose at flow levels sufficient to deliver a constant, precisely set high FiO2. Exhalation is to the open air. HFNO reduces dead space, provides low levels of PEEP, and decreases breathing frequency and work of breathing HFNC flow rates reach up to 60 L/min, whereas HVNI delivers flow rates up to 40 L/min due to differing mechanisms of delivery (4).
High velocity nasal insufflation (HVNI) utilizes a small-bore nasal cannula to generate higher velocities of gas delivery than HFNC which uses large bore cannula
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: High Flow Nasal Cannula Standard operating procedures represented by high flow nasal cannula oxygen therapy |
Device: High Flow Oxygen Therapy
• The patient will be allocated into 2 groups, patients who will require ventilatory support via HFNC and those who will require HVNI
|
| Active Comparator: High Velocity Nasal Insufflation Standard operating procedures represented by high velocity nasal insufflation therapy |
Device: High Flow Oxygen Therapy
• The patient will be allocated into 2 groups, patients who will require ventilatory support via HFNC and those who will require HVNI
|
Outcome Measures
Primary Outcome Measures
- To compare the outcomes of HFNC and HVNI in COVID-19 patients with acute respiratory failure [baseline]
need for mechanical ventilation
- changes of arterial blood gases (ABG) parameters [within 2 hours then according to clinical condition]
changes of arterial blood gases (ABG) parameters
- duration of ventilatory support [From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months]
duration of ventilatory support
- delay between admission and intubation. [baseline]
delay between admission and intubation.
Secondary Outcome Measures
- To evaluate the length of ICU stay and mortality rate in HFNC versus HVNI in COVID-19 patients [baseline]
duration of ICU stay
- mortality rate [baseline]
mortality rate
Eligibility Criteria
Criteria
Inclusion Criteria:
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COVID-19 positive by RT-PCR
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Age≥ 18 years
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Both gender
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Classical radiological lesions of COVID-19 on HRCT chest.
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Respiratory rate > 30/ min and not responding to non-rebreather masks.
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COVID-related pneumonia requiring non-invasive ventilatory support (high-flow nasal cannula, and / or non-invasive ventilation and / or CPAP)
Exclusion Criteria:
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Age < 18 years
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Patients who refuse to participate in the study
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Severe respiratory failure requiring invasive ventilatory support
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Indication of immediate tracheal intubation
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Significant acute progressive circulatory insufficiency
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Impaired conscious level
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Nasal blockade
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Assiut University
Investigators
- Study Director: Maha k Ghanem, MD, Assuit university, Egypt
Study Documents (Full-Text)
None provided.More Information
Publications
- Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020 May;46(5):854-887. doi: 10.1007/s00134-020-06022-5. Epub 2020 Mar 28.
- Doshi P, Whittle JS, Bublewicz M, Kearney J, Ashe T, Graham R, Salazar S, Ellis TW Jr, Maynard D, Dennis R, Tillotson A, Hill M, Granado M, Gordon N, Dunlap C, Spivey S, Miller TL. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Ann Emerg Med. 2018 Jul;72(1):73-83.e5. doi: 10.1016/j.annemergmed.2017.12.006. Epub 2018 Jan 6.
- Nishimura M. High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respir Care. 2016 Apr;61(4):529-41. doi: 10.4187/respcare.04577. Review.
- Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020 Jun;92(6):568-576. doi: 10.1002/jmv.25748. Epub 2020 Mar 29. Review.
- Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239-1242. doi: 10.1001/jama.2020.2648.
- HFNC VS HVNI in COVID 19