Applying an established therapy to a new disease

Des Moines University Clinic Health Topics: What is Coronavirus?

Two of the many challenges that the coronavirus thrust upon frontline medical providers were having to treat very sick patients for a disease the providers were largely learning about in real time, and facing risks to their own health in doing so. Those realities prompted Matthew Trump, D.O.’08, FACP, FCCP, and his colleagues across UnityPoint Health-Des Moines (UPH-DM) to try a novel treatment for some COVID-19 patients’ hypoxia – using high-flow nasal cannula (HFNC) rather than mechanical ventilation.

That approach is less invasive, has fewer complications and can provide some patients with enough breathing support to recover. Unlike being on a ventilator, patients who are being treated with HFNC are able to eat, talk and walk on their own.

“Early on, during the surge of cases in New York, there was a lot of talk about treating patients with intubation and ventilators,” says Trump, a pulmonary and critical care physician with the Iowa Clinic, which works with UPH-DM. “There were reports of hospitals filling up with patients quickly and getting overwhelmed. We knew we had to start planning.”

HFNC therapy, which delivers oxygen and water vapor through a tube in the nose, is not new, but applying it to a new disease was. That required countless meetings among “anybody taking care of patients,” Trump says, to assess data, prepare protocols and mobilize resources.

Their efforts reaped benefits: As of mid-May, UPHDM had treated 73 percent of its critically ill COVID-19 patients without ventilators. The total intubation rate of all the COVID-19 patients across UPH-DM’s five hospitals was 10 percent.

Other benefits: HFNC doesn’t expose providers to disease-spreading droplets from patients’ airways the way intubation can, and the therapy can be applied to patients outside of intensive care.

“We were able to manage more than half our COVID-19 patients outside the ICU, keep the ICU up and running for other surgically critical patients and preserve ICU resources,” Trump says. “That allowed the hospitals to get patients who didn’t have coronavirus the care they needed.”

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