A breath of relief: High-flow nasal oxygen in a resource-limited setting

The COVID-19 pandemic is renowned for the unprecedented burden of patients with hypoxic respiratory failure attending healthcare facilities. To date, there have been over ~500 000 COVID-19 admissions in South Africa (SA).[1] The mainstay of management for COVID-19-related respiratory distress is oxygen therapy, with more than 182 000 patients requiring supplemental oxygen and up to 27 000 requiring mechanical ventilatory support in intensive care units (ICUs).[1] In a resource-constrained setting, the demand for ICU beds far outweighs the supply during the wave peaks. Between March 2020 and February 2022 there were 58 774 ICU admissions[2] in a health system with just over 3 300 ICU beds.[3] Bearing in mind that only a third of these beds were in the public sector, which serves the majority of the population, the paucity of ICU resources is glaring. Reserving this precious resource for those who need it most can save lives. The medical community has been able to adapt by employing available oxygenation methods in innovative ways. The use of high-flow nasal cannula (HFNC) outside the ICU setting has played a pivotal role in our response to the pandemic, and in decreasing the need for invasive ventilation.[4]