High Flow Nasal Cannula (HFNC) may help in managing some less critical Covid-19 patients without the need to put them on ventilator support. This technique involves providing high pressure humidified and warm oxygen to patient through nose to allow self-breathing.
The technique works best in patients with oxygen saturation levels between 85 to 90 to prevent the need for invasive and non-invasive ventilator. The technique is popularly called ‘Airvo’, named by its manufacturer.
Dr Samrat Shah, consultant intensivist in Bhatia hospital, has used this machine on more than Covid-19 15 patients. The hospital had procured three machines — worth Rs 3.5 lakh each — in the last two months for Covid-19 patients.
“Not more than 5 to 10 per cent of patients we put on ventilator come out of it. With HFNC technique, intubation through ventilator is not needed,” said Dr R B Dastur, Medical Director in Bhatia hospital.
Shah said the technique provides oxygen at high pressure like a ventilator. “But we don’t have to sedate a patient or intubate him. A patient is breathing oxygen on his own,” he said, adding that he has recorded better survival rates using this technique.
Several Covid-19 patients who come out of ventilator have scarred lungs due to high pressure oxygen that damages their healthy alveoli and lung tissues. Doctors said with non-invasive oxygen, inflammation of healthy lung tissue can be avoided. While using HFNC, a machine with a tube is attached to the nose to provide non-invasive oxygen.
A 28-year-old doctor was recently admitted to Bhatia hospital for Covid-19 treatment with poor oxygen saturation levels. Doctors said they tried using HFNC technique to allow self-breathing, and the patient improved in 48 hours without requiring the ventilator. In some cases, patients with oxygen saturation levels below 60 to 70 require invasive ventilator.
In KEM hospital, Dean Dr Hemant Deshmukh said they use a mask, high-flow nasal cannula, or ventilator depending on the condition of the patient.
“Airvo is portable and patient can be mobilised while using it. The humidified warm air is for patients who do not have great difficulty in breathing. It provides two to 80 litres of oxygen per minute,” Deshmukh said, adding that they have been using this technique on selected Covid-19 patients.
HFNC is generally used for chronic pulmonary obstructive distress (COPD) patients. This technique is less damaging for the lungs as compared to a ventilator. “Though both are required at different points of time,” Deshmukh said.
At Breach Candy Hospital, CEO Dr N Santhanam said they are yet to use such a technique on Covid-19 patients. “We are managing our patients through other means,” he added.
Dr Rahul Pandit from Fortis hospital, which has eight of these machines, said HFNC has been used for over 15 years for COPD cases. “It generates positive pressure in lungs, and patient can talk and drink normally while using the machine. In non-coronavirus patients, we know HFNC can help in preventing need for ventilator in some cases. When it comes to Covid-19, evidence is still required but we can see that the condition of patients can stabilise on it.”
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