Clinical observation of high-flow nasal cannula (HFNC) with non-rebreather mask (NRM) use on severe or critically ill COVID-19 diabetic patients

Objective: Diabetes prevalence is a vital factor in COVID-199s clinical prognosis. This study aimed to investigate and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without non-rebreather mask (NRM) on critical COVID-19 patients with/without diabetes. Materials and methods: For analysis and comparison, epidemiological, biochemical, and clinical data were collected from 240 HFNC±NRM treated severe and critical COVID-19 ICU patients (diabetic = 136; non-diabetic = 104) of five hospitals in Chattogram, Bangladesh. Results and Discussion: 59.1% patients with fever had diabetes (p=0.012). ICU stay was longer for diabetic patients (9.06±5.70) than non-diabetic ones (7.41±5.11) (p=0.020). Majority of hypertensive patients were diabetic (68.3%; p<0.001). Most of the diabetic patients (70.4%; p<0.005) had elevated creatinine levels. The partial pressure of oxygen after HFNC (only) was significantly (p=0.031) higher in non-diabetic patients (69.30±23.56) than diabetic ones (61.50±14.49). Diabetic (62.64±13.05) and non-diabetic patients (59.40±13.22) had similar partial pressure of oxygen from HFNC+NRM. Majority of the diabetic patients who required HFNC+NRM had elevated RBS (73.8%; p=0.001) and creatinine (75.7%; p=0.009). Factors affecting the HFNC only treated patients were fever and impaired glucose tolerance. Besides, increased plasma glucose level, age, and hypertension affected the HFNC + NRM treated diabetic patients. Conclusion: The results of this study imply that oxygen supply with HFNC+NRM may be beneficial for the elderly/hypertensive diabetic patients with COVID-19 associated AHRF; and that IGT and increased blood glucose levels could be determinants for COVID-19 severity. However, further experiments to substantiate these claims are required on a larger sample and among different clinical cohorts.