Increased usage of the high flow nasal cannula in COVID-19 cases in Japan -from the online questionnaire survey by the Japanese Respiratory Society.

An online questionnaire survey was used to assess the application of noninvasive strategies in the management of COVID-19 patients. We found a marked increase in the proportion of facilities using high flow nasal cannula (HFNC) oxygen therapy successfully in the 3rd epidemic wave as compared to the 1st wave (49% vs. 12%) and rare reports of associated nosocomial infection in the medical personnel. Furthermore, the proportion of facilities using HFNC as first-line therapy for half or more than half of their patients who did not respond to conventional oxygen therapy increased from 9% in the first to 33% in the second survey. Conversely, the rate of mechanical ventilation with intubation usage following conventional oxygen therapy failure decreased from 62% to 54%. These changes could be due to the limited medical resources available during the larger 3rd wave coupled with increased internal reports on the success of HFNC.