High-flow oxygen therapy in elderly patients infected with SARS-CoV2 with a contraindication for transfer to an intensive care unit: A preliminary report

•Severe COVID-19 infections occur mostly in patients over 65 years of age.•Elderly patients with comorbidities are frequently non eligible for ICU transfer.•HFNO saved the lives of one-third of COVID-19 patients noneligible for ICU transfer. In a conventional hospital ward, we used high-flow nasal oxygen (HFNO) to treat elderly COVID-19 patients noneligible for intensive care unit transfer. This study was conducted in the Institut Hospitalo-Universitaire Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille (AP-HM), France. We used high-flow nasal oxygen (HFNO) in our conventional infectious disease ward from 15 September 2020 for elderly patients noneligible for intensive care unit transfer. Of the 44 patients (median age 83 years (57–94), mean: 80.25), 61.4% (27/44) were men. The median Charlson score was 7 (1–15). The median of the NEWS-2 score upon admission was 8 (3–11) and was 10 at the time of initiation of HFNO. The median PaO2/FiO2 ratio was 103 (71–151) prior to HNFO initiation. Among the 44 patients, 16 patients (36.4%) had been weaned from HFNO, and 28 patients had died (63.6%). In this preliminary report, we observed that HFNO saved the lives of one-third of elderly COVID-19 patients who would have systematically died.