High-flow oxygenotherapy in a Pulmonology ward in the post COVID era

Introduction: High-flow oxigenotherapy (HFO) through nasal cannulla has been increasingly used in recent years in patients with severe hypoxemic respiratory insufficiency, specially due to COVID. We aim to illustrate the usage of HFNC in a ward in the post COVID era. Methods: We selected 15 patients admitted to a Pnulmonology ward in 2023, in which HFO was used and analyzed their electronic clinical process, focusing on underlying diagnosis, context of usage of HFO, as well as outcomes. Results: We included 15 patients, with a median of 62 years, 60% (n=9) male, mostly non-smokers (n=13, 86%). Regarding main diagnosis seven patients (46%) had pulmonary infections (including 2 with COVID pneumonia), five patients (33%) had exacerbated interstitial lung disease, two patients had exacerbated airway disease and one had lung adenocarcinoma. HFO was initiated in 11 patients (73%) due to ARDS, of which seven (63%) was moderate and only one (9%) was severe, with palliative intent in three patients (20%) and in weaning of invasive mechanical ventilation in one (6%).  Settings ranged from 35 to 60 L/minute and 35 to 50% of FiO2. In medium there were gains of 14mmHg in paO2 and of 6% of peripheral saturation of O2. Duration of high-flow oxigenotherapy was in medium 12 days and most patients were able to de-escalate to conventional oxigenotherapy, but two patients went on to use HFO at home. Therapeutic failure was verified in three patients (20%) two of which died. Conclusion: High-flow oxygenotherapy has been used successfully in patients with ARDS and several underlying respiratory diseases, as well as with paliative intent.