High-flow Nasal Cannula therapy: A feasible treatment for vulnerable elderly COVID-19 patients in the wards

•HFNC is a potential feasible rescue respiratory treatment strategy for frail elderly COVID-19 patients.•Using HFNC in fragile COVID-19 patients in the wards results in a survival rate of 25%.•For fragile COVID-19 ICU and frail HFNC patients in the wards mortality is comparable. Invasive mechanical ventilation is the treatment of choice in COVID-19 patients when hypoxemia persists, despite maximum conventional oxygen administration. Some frail patients with severe hypoxemic respiratory failure are deemed not eligible for invasive mechanical ventilation. To investigate whether High-flow nasal cannula (HFNC) in the wards could serve as a rescue therapy in these frail patients. This retrospective cohort study included frail COVID-19 patients admitted to the hospital between March 9th and May 1st 2020. HFNC therapy was started in the wards. The primary endpoint was the survival rate at hospital discharge. Thirty-two patients with a median age of 79.0 years (74.5–83.0) and a Clinical Frailty Score of 4 out of 9 (3–6) were included. Only 6% reported HFNC tolerability issues. The overall survival rate was 25% at hospital discharge. This study suggests that, when preferred, HFNC in the wards could be a potential rescue therapy for respiratory failure in vulnerable COVID-19 patients.