Department of Medicine, University of Toronto, Toronto, Canada.
Division of Clinical Pharmacology & Toxicology, Sunnybrook Health Sciences Centre, Toronto, Canada.
J Gen Intern Med. 2023 Apr;38(5):1160-1166. doi: 10.1007/s11606-022-07949-9. Epub 2023 Jan 20.
Hospitals expanded critical care capacity during the COVID-19 pandemic by treating COVID-19 patients with high-flow nasal cannula oxygen therapy (HFNC) in non-traditional settings, including general internal medicine (GIM) wards. The impact of this practice on intensive care unit (ICU) capacity is unknown.
To describe how our hospital operationalized the use of HFNC on GIM wards, assess its impact on ICU capacity, and examine the characteristics and outcomes of treated patients.
Retrospective cohort study of all patients treated with HFNC on GIM wards at a Canadian tertiary care hospital.
All patients admitted with COVID-19 and treated with HFNC on GIM wards from December 28, 2020, to June 13, 2021, were included.
We combined administrative data on critical care occupancy daily with chart-abstracted data for included patients to establish the total number of patients receiving ICU-level care at our hospital per day. We also collected data on demographics, medical comorbidities, illness severity, COVID-19 treatments, HFNC care processes, and patient outcomes.
We treated 124 patients with HFNC on the GIM wards (median age 66 years; 48% female). Patients were treated with HFNC for a median of 5 days (IQR 3 to 8); collectively, they received HFNC for a total of 740 hospital days, 71% of which were on GIM wards. At peak ICU capacity strain (144%), delivering HFNC on GIM wards added 20% to overall ICU capacity by managing up to 14 patients per day. Patients required a median maximal fraction of inspired oxygen of 80% (IQR 60 to 95). There were 18 deaths (15%) and 85 patients (69%) required critical care admission; of those, 40 (47%) required mechanical ventilation.
With appropriate training and resources, treatment of COVID-19 patients with HFNC on GIM wards appears to be a feasible strategy to increase critical care capacity.
在 COVID-19 大流行期间，医院通过在非传统环境中（包括普通内科病房）使用高流量鼻导管给氧疗法（HFNC）治疗 COVID-19 患者来扩大重症监护能力。这种做法对重症监护病房（ICU）能力的影响尚不清楚。
描述我们医院如何在普通内科病房实施 HFNC 治疗，评估其对 ICU 能力的影响，并检查接受治疗的患者的特征和结局。
对一家加拿大三级保健医院普通内科病房接受 HFNC 治疗的所有患者进行回顾性队列研究。
所有因 COVID-19 入院并在 2020 年 12 月 28 日至 2021 年 6 月 13 日期间在普通内科病房接受 HFNC 治疗的患者均被纳入研究。
我们将每日 ICU 入住情况的行政数据与纳入患者的图表摘录数据相结合，以确定我们医院每天接受 ICU 级护理的患者总数。我们还收集了患者的人口统计学、合并症、疾病严重程度、COVID-19 治疗、HFNC 护理过程和患者结局的数据。
我们在普通内科病房用 HFNC 治疗了 124 名患者（中位年龄 66 岁；48%为女性）。患者接受 HFNC 治疗的中位时间为 5 天（IQR 3 至 8）；他们总共接受了 740 天的 HFNC 治疗，其中 71%在普通内科病房。在 ICU 容量紧张达到峰值（144%）时，通过每天管理多达 14 名患者，在普通内科病房使用 HFNC 治疗可使 ICU 总容量增加 20%。患者所需的中位吸入氧分数最高为 80%（IQR 60 至 95）。有 18 人死亡（15%），85 人（69%）需要入住 ICU；其中 40 人（47%）需要机械通气。
在适当的培训和资源的支持下，在普通内科病房使用 HFNC 治疗 COVID-19 患者似乎是增加重症监护能力的一种可行策略。
