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At the time of this writing, the horrors of the COVID-19 pandemic seem to be securely encoded into long-term memory. But the fears created by the stress and strain on health care infrastructure continue to generate coping strategies. In this issue of the Journal, Solis et al1 describe events in their hospital oxygen system related to oxygen supply shortages related to overuse of high-flow nasal cannulas (HFNCs) as a form of oxygen therapy.
In March 2020, Araba University Hospital (in the Basque Country, Spain) was among the first in the region to feel the impact of the COVID-19 pandemic. Due to a shortage of noninvasive ventilators, it was decided to increase the number of HFNC oxygen therapy devices. The increased number of patients requiring oxygen therapy, their severity, and the implementation of HFNC oxygen therapy led to a dramatic increase in oxygen use. They observed that < 5% of patients were consuming two-fifths (41%) of the hospital oxygen system at times of peak demand. They noted that HFNC oxygen therapy at 60 L/min with FIO2 between 0.6–1.0 consumes between 2 and 4 times the oxygen used in therapy with a reservoir oxygen mask. Their use of HFNC oxygen therapy together with the overall large number of patients requiring oxygen therapy in the hospital strained the hospital oxygen system, creating various bottlenecks, each of which alone could have caused a catastrophic accident. These authors describe, in minute detail, how they addressed the oxygen shortage issue by redesigning their hospital oxygen system. They conclude that the design criteria for storage and distribution networks of medical gases in hospital oxygen systems need to be revised considering new parameters for their implementation and the use of HFNC oxygen therapy in an ICU. In particular, the cryogenic tanks, evaporators, and piping network …
Correspondence: Robert L Chatburn MHHS RRT RRT-NPS FAARC. E-mail: chatbur{at}CCF.org
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