Less invasive than a ventilator, high-flow nasal cannula provides breathing relief for patients

Doctors around the world continue to learn about the coronavirus, how it spreads, and more importantly, how to better treat those who are fighting it. 

One key factor is ensuring patients are getting all the oxygen they need to recover and that doesn't always have to involve the use of a ventilator. 

At the start of the COVID-19 pandemic, one of the main concerns was a growing need and potential shortage of ventilators.

"We started this in March. We really didn't know everything about the virus," said Dr. Jason Wilson of Tampa General Hospital. "We started running out of ventilators. Not here in Tampa but in New York City and other places."

Inflamed lungs can cause patients' oxygen levels to plummet. But another type of oxygen delivery is helping some patients (and those treating them) breathe easier, without immediately resorting to a ventilator.

"We can rapidly deliver large amounts of oxygen to the patient, at high volumes in a comfortable way, that allows them to stay awake and participate in oxygenation and it's worked really well," said Dr. Wilson.

Through the use of a heated, high-flow nasal cannula (HHFNC) system, heated, humidified air is blown through the nose, quickly boosting oxygen saturation in patients who are sick but less severe.

"That sort of middle ground of not super sick, but pretty sick, but can't go home and probably needing some intensive care," Wilson described.

It's less invasive. Patients aren't sedated so they can text family members, talk to nurses or watch TV. Tampa General Hospital says HHFNC systems are helping doctors conserve resources, like staff and ICU beds, while saving ventilators for those most in need.

Dr. Wilson recalled a recent case with quick results.

"Within a matter of five minutes, the patient had gone from about 50% oxygen saturation, sweating, unable to talk because they were breathing so quickly and working so hard to breathe, to an oxygen saturation of 100%," he said.

Systems like this are being relied on around the country.

"The demand, frankly, is off the charts," said Dr. Michael McQueen, VP of Medical Affairs for Vapotherm, Inc.

New Hampshire-based Vapotherm, which manufactures its own high-flow nasal cannula system, has scaled up production 20-fold to get orders out in a day or two. They've also doubled the number of clinical educators helping facilities implement the technology along with online education.

"Certainly, nobody wanted this COVID pandemic and we all wish it would go away sooner rather than later. It doesn't look like it's going to," McQueen said. "It feels good to help. It feels good to be the right tool at the right time."

With each day, doctors learn more about which treatment strategies work for each type of patient, leading to better care, shorter hospital stays and more lives saved.

"The last time I worked a clinical shift, just a couple of days ago, I put four patients on high-flow nasal cannula and probably avoided those intubations and ventilations," Wilson said.