High Flow Nasal Cannula HFNC In Covid-19 Patients

Study Overview
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Brief Summary
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Many non-invasive ventilatory choices are available for COVID-19 patient who are having mild to moderate respiratory distress and their use will decrease the chance of ICU admission, intubation and mechanical ventilation in severe cases of COVID-19. However, all these respiratory supports and oxygen supply devices are aerosol generating and their selection should be precised enough to control nosocomial spread. High flow nasal cannula HFNC is a device that delivered the warmed and humid air on high flow rate through nose. It is used to treat severe respiratory distress in COVID-19 patients, a non-invasive ventilatory approach which is relative comfortable by using humidified and pre-heated air containing large concentration of oxygen. In acute respiratory failure HFNC is proven to be very effective and it also reduced the need of mechanical ventilation in severe patients. Apart from the supply of oxygen, HFNC generating positive airway pressure and decreasing the rebreathing from anatomical dead space. Prone position is also a save therapy and has been proven to be effective for refractory hypoxia by increasing tidal volume, oxygenation and diaphragmatic functions in ARDS patients. Recent studies showed that prone positioning and HFNC might avoid the prerequisite of intubation in moderate to severe patients of ARDS and as a result it decreases the nosocomial infection in physicians who are doing these aerosol generating procedures.

Detailed Description
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This is observational single-center study, that will be done at Lahore General Hospital in which 95 beds are allocated for COVID-19 patients including ICUs and HDUs. Ethical approval will be obtained from research ethical committee of Lahore General hospital, Lahore. Informed consent will be obtained from all patients who will agree to publish their data in this research. We will protect patient's privacy and obey with the Helsinki Declaration.

Official Title
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Prone Positioning and High Flow Nasal Canula (HFNC) Therapy: A Game Changer in COVID-19 Outcome

Conditions
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SARS-CoV Infection, SARS (Severe Acute Respiratory Syndrome)

Intervention / Treatment
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* Device: High flow nasal cannula HFNC


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients of > 18 years of ages, males and females who will be diagnosed COVID-19 positive by RT-PCR with moderate illness. Patients having classical radiological lesions of COVID-19 on X-ray chest or HRCT chest. Respiratory rate > 30/ min and not responding to non-rebreather masks. COVID-related pneumonia requiring non-invasive ventilatory support (high-flow nasal cannula, and / or non-invasive ventilation and / or CPAP) Exclusion Criteria: Inability to provide consent; Severe respiratory failure requiring invasive ventilatory support; Indication of immediate tracheal intubation Significant acute progressive circulatory insufficiency Impaired alertness, confusion, restlessness Chest trauma or other contraindication to prone position Pneumothorax Nasal blockade Unable to tolerate high flow oxygen

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: quasi- experimental
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group intervene with HFNC<br>Review effect of HFNC as clinical trial among hospitalized patients with COVID-19 infection. | Device: High flow nasal cannula HFNC<br>* High flow nasal cannula HFNC is a device that delivered the warmed and humid air on high flow rate through nose. It is used to treat severe respiratory distress in COVID-19 patients, a non-invasive ventilatory approach which is relative comfortable by using humidified and pre-heated air containing large concentration of oxygen.<br>* Other names: HFNC;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical response of HFNC | The number of patients treated with non-invasive ventilation devices. HFNC related events (hot air feeling, nasal lesions) | 10 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of intervention | Length of HFNC therapy to COVID-19 patients | 15 days | 
| Duration of hospitalization | Number of days of hospital admission either in ICU or HDUs till date of discharge | 15 days | 
| Supplemental Oxygen Requirement from Baseline | Duration of increased supplemental oxygen requirement from baseline | 15 days | 
| Radiological outcome | Follow up radiological response HR-CT. | 15 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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COVID-19, High flow nasal cannula HFNC, Clinical outcome