CAPE TOWN- Doctors from two of the Western Cape’s most impacted Covid-19 hospitals say they have seen success in treating critical patients with high-flow nasal oxygen (HFNO). This non-invasive oxygen therapy has been used as an alternative to mechanical ventilation.
Groote Schuur Hospital (GSH) recently discharged five patients from its Intensive Care Unit (ICU) wards to normal wards after they were treated with HFNO.
Chief of Operations for the Western Cape Health Department, Dr Saadiq Kariem, said in a media briefing that the province has 121 HFNO machines available at its tertiary hospitals, with another 42 on the way.
“It’s made a real difference in Groote Schuur and Tygerberg and we are preparing for high-flow oxygen to be used as an alternative to people having to be on ventilators. HFNO can be provided not only in a high-care bed, but we have also been providing it in a normal, acute bed. That relieves some pressure on our high-care beds, and that’s generally the strategy at all our hospitals and facilities,” said Kariem.
In an article on Spotlight, co-manager the Tygerberg Covid-19 ICU Professor Coenie Koegelenberg says the outcome of patients who are intubated on a ventilator is not good, however, they have seen positive outcomes for patients treated with HFNO.
“Once intubated most will not survive, and those that do survive take about three to four weeks to be liberated from the ventilator and to be discharged and that’s a very long time. It means that they occupy a bed for approximately a month, at least three weeks in ICU, whereas with HFNO it’s less than a week,” said Koegelenberg.
Around 200 ICU patients have undergone the HFNO treatment and the survival rate is 60% according to Tygerberg’s available data.
The HFNO machine blends and humidifies a combination of oxygen and normal room air to give a certain percentage of breathable oxygen to the patient. This oxygen flows at a very high rate and has the ability to increase oxygenation by washing out the ‘dead space’ in the lungs, or the parts that do not take part in oxygen exchange.
For some severe Covid-19 cases, doctors find that the patient’s oxygen levels have been dangerously low, or ‘hypoxic’, and are classified as having Acute Respiratory Distress Syndrome (ARDS).
When a patient becomes hypoxic they are not able to absorb enough oxygen in their lungs and create functioning alveoli and which is needed to come in contact with their blood.
The HFNO treatment works by continuously flushing out the amount of oxygen that a patient breathes at the level of the alveoli.
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