Epistaxis in COVID positive ICU patients, implications, and future interventions

Area of Science:

• Critical Care Medicine
• Otolaryngology
• Infectious Diseases

Background:

• Epistaxis (nosebleeds) complicates care for critically ill patients, potentially hindering non-invasive ventilation and nasal oxygen delivery.
• The widespread use of high-flow nasal oxygen (HFNO) during the COVID-19 pandemic necessitates understanding its impact on epistaxis in this population.
• Limited research exists on epistaxis characteristics in critically ill patients with COVID-19.

Purpose of the Study:

• To determine the incidence of epistaxis in critically ill, COVID-19 positive patients.
• To identify specific risk factors associated with epistaxis in this patient group.
• To inform preventative strategies for epistaxis in intensive care settings.

Main Methods:

• Retrospective observational study at a major academic medical center.
• Chart review of intensive care unit (ICU) patients diagnosed with COVID-19 between January 2020 and May 2022.
• Data collected included epistaxis events, duration and type of supplemental oxygen, and use of anticoagulation and antiplatelet therapies.

Main Results:

• The study included 932 patients, with an epistaxis incidence of 7.4%.
• Among patients experiencing epistaxis, 78% received supplemental oxygen.
• Each additional day of nasal oxygen administration increased the risk of epistaxis by 7.1% (p < .001).
• Therapeutic anticoagulation and most antiplatelet agents did not significantly increase epistaxis risk.

Conclusions:

• Prolonged nasal oxygen use is a primary risk factor for epistaxis in critically ill COVID-19 patients.
• Standard otolaryngologist recommendations include nasal hygiene for epistaxis prevention.
• Integrating nasal hygiene measures into care protocols could be a simple, cost-effective method to reduce epistaxis in this vulnerable patient cohort.