Case Studies

Innovation in High-Flow Respiratory Support Systems for Emergency Management during the COVID-19 Pandemic

In 2021, COVID-19 spread rapidly worldwide, including in Thailand, driven by outbreaks of the Alpha and Delta variants from April to July. This resulted in 363,029 confirmed cases and 2,934 deaths in July 2021. Many COVID-19 patients experienced severe symptoms, including pneumonia and acute respiratory distress syndrome, requiring the use of ventilators and high-flow nasal therapy devices. This led to a shortage of both types of equipment as they couldn’t be procured from foreign manufacturers due to a global shortage. Therefore, it became necessary for the Faculty of Medicine, Chulalongkorn University, and the Thai Red Cross Society to expedite efforts to produce high-flow respiratory therapy devices. The objective was to ensure the availability of quality equipment in sufficient quantities to treat severe COVID-19 patients whose numbers were increasing rapidly, thus enabling effective medical care and enhancing the country’s medical self-sufficiency, especially in crisis situations.

This project developed innovative high-flow respiratory therapy devices for emergency use during the COVID-19 pandemic, which had not been previously researched or produced in Thailand. Collaboration between government and private sector entities, including the Faculty of Medicine, Chulalongkorn University, the Thai Red Cross Society, Food and Drug Administration, Intronics Co., Ltd., and Thai Beverage Pub Co., Ltd, played a significant role in the design, engineering, and medical testing, electrical safety compliance, and accuracy of the equipment. An equivalent test comparing the treatment results of COVID-19 patients using these devices with imported ones showed comparable effectiveness.

The project received approximately 50 million baht in public funding, which supported the production of 500 devices. These were distributed to 183 hospitals across 42 provinces, ensuring nationwide coverage. Comprehensive training materials, videos, and sessions educated medical staff and other users on proper device operation. A communication network was also established for troubleshooting issues, monitoring usage, and ongoing support.

The highest daily mortality rate was recorded during the project’s initial phase, with 257-260 deaths per day in late August 2021. When distribution of this innovation began on October 8, 2021, there were still 116 daily deaths. However, the average 7-day mortality rate dropped to below 20 deaths per day in early October 2022. Furthermore, more than 5,000 severe COVID-19 patients across the country received treatment during the project’s implementation.

While the COVID-19 situation in Thailand has improved, the project continues to monitor the usage of high-flow respiratory therapy devices throughout 2022. Up to 80% of hospitals continue using the equipment throughout the year, treating more than 2,000 patients. Regarding the availability of compatible equipment used alongside high-flow respiratory therapy devices, it was found that 37% of hospitals were found to have sufficient stock. Meanwhile, 63% had the capability to procure more as needed. This reflects the successful integration and adoption of these innovations across various hospitals nationwide.

In conclusion, the development of high-flow respiratory therapy devices represents a groundbreaking service innovation never implemented. It has significantly enhanced the effectiveness of COVID-19 treatment in Thailand, reduced patient mortality rates, and made vital contributions to public health and healthcare system resilience.


  • Faculty of Medicine, Chulalongkorn University
  • The Thai Red Cross Society

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