scholarly journals Comparison of the Discrimination Capacity of the ROX and HACOR Scales to Predict High-flow Nasal Cannula Failure in Patients With SARS-CoV-2 Pneumonia

2021 ◽  
Author(s):  
Oscar Lucero ◽  
Carlos Fernando Valencia ◽  
Onofre Casas Castro ◽  
Andrey Sanko ◽  
Peter Alfonso Olejua
Keyword(s):  
Diagnostic Tests ◽  
Retrospective Cohort ◽  
Invasive Mechanical Ventilation ◽  
Area Under The Curve ◽  
Orotracheal Intubation ◽  
High Flow ◽  
Composite Outcome ◽  
High Flow Nasal Cannula ◽  
Predictive Capacity ◽  
Discrimination Capacity

Abstract BackgroundThe pandemic of SARSCov2 infection has created a challenge in health services worldwide. Some scales have been applied to evaluate the risk of intubation, such as the ROX and HACOR. The objective of this study is to compare the predictive capacity of the HACOR scale and the ROX index and define the optimal cut-off points.MethodsStudy of diagnostic tests based on a retrospective cohort. Composite outcome was the proportion of patients that needed orotracheal intubation or died of COVID19 pneumonia. Discrimination capacity was compared by the area under the curve of each of the two scales and the optimal cut-off point was determined using the Liu method.Results245 patients were included, of which 140 (57.14%) required OTI and 152 (62.04%) had the composite end result of HFNC failure. The discrimination capacity was similar for the two scales with an AUROC of 0.71 and 0.72 for the HACOR scale for the ROX index, respectively. The optimal cut-off point for the ROX index was 5.62 (sensitivity 62% specificity 65%), while the optimal cut-off point for the HACOR scale was 5.5 (sensitivity 66% specificity 65%).ConclusionsThe HACOR scale and the ROX index have a moderate predictive capacity to predict failures to the HFNC strategy. They can be used in conjunction with other clinical variables to define which patients may require invasive mechanical ventilation.

scholarly journals Comparison of ROX and HACOR scales to predict high-flow nasal cannula failure in patients with SARS-CoV-2 pneumonia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Carlos Fernando Valencia ◽  
Oscar David Lucero ◽  
Onofre Casas Castro ◽  
Andrey Alexandrovich Sanko ◽  
Peter Alfonso Olejua
Keyword(s):  
Operating Characteristic ◽  
Characteristic Curve ◽  
Invasive Mechanical Ventilation ◽  
Area Under The Curve ◽  
High Flow ◽  
Nasal Cannula ◽  
Composite Outcome ◽  
High Flow Nasal Cannula ◽  
Predictive Capacity ◽  
Discrimination Capacity

AbstractThe pandemic of SARSCov2 infection has created a challenge in health services worldwide. Some scales have been applied to evaluate the risk of intubation, such as the ROX and HACOR. The objective of this study is to compare the predictive capacity of the HACOR scale and the ROX index and define the optimal cut-off points. Study of diagnostic tests based on a retrospective cohort. Composite outcome was the proportion of patients that needed endotracheal intubation (ETI) or died of COVID19 pneumonia. Discrimination capacity was compared by the area under the curve of each of the two scales and the optimal cut-off point was determined using the Liu method. 245 patients were included, of which 140 (57%) required ETI and 152 (62%) had the composite end result of high-flow nasal cannula (HFNC) failure. The discrimination capacity was similar for the two scales with an area under receiver operating characteristic curve of 0.71 and 0.72 for the HACOR scale for the ROX index, respectively. The optimal cut-off point for the ROX index was 5.6 (sensitivity 62% specificity 65%), while the optimal cut-off point for the HACOR scale was 5.5 (sensitivity 66% specificity 65%). The HACOR scale and the ROX index have a moderate predictive capacity to predict failures to the HFNC strategy. They can be used in conjunction with other clinical variables to define which patients may require invasive mechanical ventilation.

scholarly journals Protocolized Post-Extubation Respiratory Support to prevent reintubation: protocol and statistical analysis plan for a clinical trial

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030476 ◽  
Author(s):  
Jonathan Dale Casey ◽  
Erin R Vaughan ◽  
Bradley D Lloyd ◽  
Peter A Bilas ◽  
Eric J Hall ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Usual Care ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients

IntroductionFollowing extubation from invasive mechanical ventilation, nearly one in seven critically ill adults requires reintubation. Reintubation is independently associated with increased mortality. Postextubation respiratory support (non-invasive ventilation or high-flow nasal cannula applied at the time of extubation) has been reported in small-to-moderate-sized trials to reduce reintubation rates among hypercapnic patients, high-risk patients without hypercapnia and low-risk patients without hypercapnia. It is unknown whether protocolised provision of postextubation respiratory support to every patient undergoing extubation would reduce the overall reintubation rate, compared with usual care.Methods and analysisThe Protocolized Post-Extubation Respiratory Support (PROPER) trial is a pragmatic, cluster cross-over trial being conducted between 1 October 2017 and 31 March 2019 in the medical intensive care unit of Vanderbilt University Medical Center. PROPER compares usual care versus protocolized post-extubation respiratory support (a respiratory therapist-driven protocol that advises the provision of non-invasive ventilation or high-flow nasal cannula based on patient characteristics). For the duration of the trial, the unit is divided into two clusters. One cluster receives protocolised support and the other receives usual care. Each cluster crosses over between treatment group assignments every 3 months. All adults undergoing extubation from invasive mechanical ventilation are enrolled except those who received less than 12 hours of mechanical ventilation, have ‘Do Not Intubate’ orders, or have been previously reintubated during the hospitalisation. The anticipated enrolment is approximately 630 patients. The primary outcome is reintubation within 96 hours of extubation.Ethics and disseminationThe trial was approved by the Vanderbilt Institutional Review Board. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.Trial registration numberNCT03288311.

scholarly journals An Analysis of the Risk Factors for the Failure of Respiratory Support With High-flow Nasal Cannula Oxygen Therapy in Children with Acute Respiratory Dysfunction:a case-control study

2020 ◽  
Author(s):  
jie liu ◽  
Li-na QIAO ◽  
De-yuan LI ◽  
Li-li LUO ◽  
Zhong-qiang LIU ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Invasive Mechanical Ventilation ◽  
Oxygenation Index ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Failure Group ◽  
Before And After ◽  
Change Trend

Abstract Background:Different causes of acute respiratory insufficiency threaten the lives of pediatric patients, while High-flow nasal cannula oxygen therapy (HFNC) is a new type of non-invasive respiratory support technique that widely used in pediatric intensive care units (PICUs);however, improper use of HFNC is likely to bring adverse consequences to critically ill children.Our objective in this study was to identify the risk factors for the failure of HFNC, that can guide clinicians during managing of HFNC treatment correctly.Methods: Divided the patients into different categories: HFNC success group (237 patients), a 48 h failure group (112 patients), a 24 h failure group (84 patients), and a 2 h failure group (24 patients). The clinical indexes and the change trend in HFNC before and after treatment were dynamically observed in 67 pediatric patients. Risk factors for HFNC failure were determined using multivariate logistic regression analysis.Results:PRISM III score >4 points and PaCO2 >43 mmHg were risk factors for 48 h failure (OR were 4.064, 4.516, P<0.05); PaCO2 >43 mmHg was risk factors for 24 h failure (OR was 3.152, P<0.05); PRISM III score >6.5 points and PaCO2/PaO2 ratio >0.67 were risk factors for 2 h failure (OR were 27.977, 64.366, P<0.05) and the risk of HFNC failure increased more than 5 times when the oxygenation index decreased by >28% after 2 h of HFNC treatment, and the invasive mechanical ventilation time was statistically longer in the patients that upgraded from HFNC to invasive respiratory support than that of patients who received invasive respiratory support directly(P<0.05).Conclusions: The PRISM III score, PaCO2 and PaCO2/PaO2 ratio were risk factors for HFNC failure. Totally the shorter the failure time, the higher the values of the risk factors were, and the higher the failure risk of HFNC was. The change trend in oxygenation index before and after HFNC is a warning factor for early HFNC failure. And early HFNC failure might lead to prolonged invasive mechanical ventilation.

scholarly journals High flow nasal cannula in asthmatic children with suspected COVID-19

2021 ◽  
Vol 34 ◽  
Author(s):  
Valéria Cabral Neves ◽  
Joyce de Oliveira de Souza ◽  
Adriana Koliski ◽  
Bruno Silva Miranda ◽  
Debora Carla Chong e Silva
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Rate ◽  
Clinical Data ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Gradual Improvement ◽  
Arterial Blood

Abstract Introduction: The use of a high-flow nasal cannula as an alternative treatment for acute respiratory failure can reduce the need for invasive mechanical ventilation and the duration of hospital stays. Objective: The present study aimed to describe the use of a high-flow nasal cannula in pediatric asthmatic patients with acute respiratory failure and suspected COVID-19. Methods: To carry out this research, data were collected from medical records, including three patients with asthma diagnoses. The variables studied were: personal data (name, age in months, sex, weight, and color), clinical data (physical examination, PRAM score, respiratory rate, heart rate, and peripheral oxygen saturation), diagnosis, history of the current disease, chest, and laboratory radiography (arterial blood gases and reverse-transcriptase polymerase chain reaction). Clinical data were compared before and after using a high-flow nasal cannula. Results: After the application of the therapy, a gradual improvement in heart, respiratory rate, PaO2/FiO2 ratio, and the Pediatric Respiratory Assessment Measure score was observed. Conclusion: The simple and quick use of a high-flow nasal cannula in pediatric patients with asthma can be safe and efficient in improving their respiratory condition and reducing the need for intubation.

scholarly journals Clinical Management of Critical COVID-19 Patients: Insights from the Literature and “On the Field” Experience

2020 ◽  
Vol 07 (02) ◽  
pp. 054-061 ◽  
Author(s):  
Francesco Alessandri ◽  
Federico Bilotta ◽  
Giancarlo Ceccarelli ◽  
Franco Ruberto ◽  
Fabio Araimo ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Clinical Management ◽  
Field Experience ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Virus Spread ◽  
High Flow Nasal Cannula ◽  
Hemodynamic Management ◽  
The World ◽  
Recent Outbreak

AbstractThe recent outbreak of the coronavirus disease (COVID-19) is a health emergency all over the world. Several health care professionals are currently putting their best efforts to deal with this situation. The aim of this review is to report insights from the literature and “on the field” experience in clinical management of critical COVID-19 patients. Respiratory support varies from high flow nasal cannula (HFNC) to noninvasive and invasive mechanical ventilation, often associated with nitric oxide, prone position, and extracorporeal membrane oxygenation (ECMO). Experienced specialists have to manage the airways minimizing any contamination and virus spread. The hemodynamic management of critical COVID-19 patients requires not only an accurate fluid strategy, but also an appropriate use of vasopressors and inotropes. Various adjuvant treatments have been proposed: antiviral drugs, immunomodulators, anticoagulants, antibiotics, and nutrition.

scholarly journals The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 620
Author(s):  
Francesca Simioli ◽  
Anna Annunziata ◽  
Giorgio Emanuele Polistina ◽  
Antonietta Coppola ◽  
Valentina Di Spirito ◽  
...  
Keyword(s):  
Subcutaneous Emphysema ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
High Resolution Computed Tomography ◽  
Positive Role ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Critical Patients

Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and pneumothorax in SARS-CoV2-Acute Respiratory Distress Syndrome (ARDS), what symptoms may predict a severe and potentially fatal complication and what therapeutical approach may provide a better outcome. Methods: In this single center cohort study, we recorded data from 45 critically ill COVID-19 patients who developed one or more complicating events among pneumomediastinum, subcutaneous emphysema and pneumothorax. All patients showed ARDS and underwent non-invasive ventilation (NIV) at baseline. Patients with mild to moderate ARDS and pneumomediastinum/pneumothorax (n = 25) received High Flow Nasal Cannula (HFNC), while patients with severe ARDS and pneumomediastinum/pneumothorax underwent HFNC (n = 10) or invasive mechanical ventilation (IMV) (n = 10). Results: Pneumomediastinum/pneumothorax developed in 10.5% of subjects affected by SARS-coV2-ARDS. Dyspnea affected 40% and cough affected 37% of subjects. High resolution computed tomography of the chest showed bilateral diffuse ground glass opacities (GGO) in 100% of subjects. Traction bronchiolectasis, reticulation, crazy paving and distortion were observed in 64%. Furthermore, 36% showed subcutaneous emphysema. Non-severe ARDS cases received HFNC, and 76% patients recovered from pneumomediastinum/pneumothorax over a median follow up of 5 days. Among severe ARDS cases the recovery rate of pneumomediastinum/pneumothorax was 70% with the HFNC approach, and 10% with IMV. Conclusion: HFNC is a safe and effective ventilatory approach for critical COVID-19 and has a positive role in associated complications such as pneumomediastinum and pneumothorax.

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