Case Reports in Critical Care

Case Report

The Considerations and Controversies in Using High-Flow Nasal Oxygen with Self-Prone Positioning in SARS-CoV-2 COVID-19 Disease

Table 2

A case series of our patients treated with high-flow nasal oxygen during the first wave of the COVID-19 pandemic.


Age (years)	Gender	Comorbidities	ICU admission P:F (mmHg)	Initial HFNO P:F (mmHg)	Intubated	Preintubation P:F on HFNO (mmHg)	Proned (i = intubated)	Preprone P:F (mmHg)	Postprone P:F (mmHg)	Preextubation P:F (mmHg)	Outcome

63	M	HTN, BMI, DM	96	113 (FiO₂ 0.6, flow 40 L/min)	Y	57 (FiO₂ 1.0, flow 50 L/min)	Y (i)	98 (FiO₂ 0.7)	222 (FiO₂ 0.45)	Tracheostomy	I
44	M	BMI, DM	66	93 (FiO₂ 1.0, flow 60 L/min)	Y	50 (FiO₂ 1.0, flow 60 L/min)	Y (i)	101 (FiO₂ 0.55)	140 (FiO₂ 0.45)	187 (FiO₂ 0.4)	D/C
60	M		61	71 (FiO₂ 0.9, flow 65 L/min)	Y	60 (FiO₂ 1.0, flow 60 L/min)	Y (i)	128 (FiO₂ 0.5)	88 (FiO₂ 0.75)	N/A	Died
68	M	HTN, BMI, PAF, CMT	183	165 (FiO₂ 0.6, flow 60 L/min)	Y	135 (FiO₂ 0.55, flow 50 L/min)	Y (i)	113 (FiO₂ 0.9)	285 (FiO₂ 0.55)	N/A	Died
66	M	TIA, HT	68	59 (FiO₂ 1.0, flow 60 L/min)	Y	N/A (immediate progression)	Y (i)	N/A (immediate progression)	135 (FiO₂ 0.55)	N/A	Died
66	M	DM, A	116	116 (FiO₂ 0.5, flow 60 L/min)	N	N/A	Y	90 (FiO₂ 0.5)	103 (FiO₂ 0.6)	N/A	D/C
65	M	HTN, BMI, DM	105	144 (FiO₂ 0.9, flow 50 L/min)	N	N/A	Y	105 (FiO₂ 0.6)	104 (FiO₂ 0.8)	N/A	D/C
67	M	NHL-R	112	116 (FiO₂ 0.65, flow 40 L/min)	Y	143 (FiO₂ 60%, flow 40 L/min)	N	N/A	N/A	N/A	Died
53	F	HTN, BMI, DM, S, RA-R	81	126 (FiO₂ 0.60, flow 50 L/min)	N	N/A (immediate progression)	Y	Not available	Not available	187 (FiO₂ 0.35)	D/C
47	M	DM, GPA-R	77	65 (FiO₂ 0.8, flow 60 L/min)	Y	67 (FiO₂ 0.8, flow 50 L/min)	Y (i)	11	83 (FiO₂ 0.9)	Tracheostomy	D/C
53	M		99	117 (FiO₂ 0.6, flow 50 L/min)	N	N/A	Y	Not available	Not available	N/A	D/C
45	M	BMI, G	90	104 (FiO₂ 0.7, flow 50 L/min)	Y	62 (FiO₂ 0.9, flow 60 L/min)	N	N/A	N/A	210 (FiO₂ 0.35)	D/C
54	M	AML	54	HFNC applied for palliation	N	N/A	N	N/A	N/A	N/A	Died
30	M	BMI, A	150	101 (FiO₂ 0.55, flow 50 L/min)	Y	49 (FiO₂ 0.75, flow 45 L/min)	Y (i)	105 (FiO₂ 0.5)	128 (FiO₂ 0.55)	Tracheostomy	D/C
18	F	BMI, F, D	107	108 (FiO₂ 0.6, flow 60 L/min)	N	N/A	Y	161 (FiO₂ 0.7)	329 (FiO₂ 0.4)	N/A	D/C
51	M	A	141	95 (FiO₂ 0.8, flow 60 L/min)	N	N/A	Y	Not available	Not available	N/A	D/C

Legend: HTN: hypertension; BMI: ; DM: type 2 diabetes; A: asthma; S: smoker; PAF: paroxysmal atrial fibrillation; CMT: Charcot-Marie-Tooth; TIA: transient ischaemic attack; HT: hypothyroid; NHL-R: non-Hodgkin lymphoma-taking rituximab; RA-R: rheumatoid arthritis-taking rituximab; GPA-R: granulomatosis with polyangiitis-taking rituximab; G: gout; AML: acute myeloid leukaemia; F: fibromyalgia; D: depression. Our preference and new admissions were treated with HFNO using the Optiflow+ setup detailed in the case report. If there was a demand on equipment or the patient was later in the phase of weaning or being extubated to HFNO, then we did also deliver HFNO by the Dräger Evita® Infinity® V500 ventilator. I = inpatient; D/C = discharged home; died = death in intensive care.