Role of SpO2/FiO2 Ratio and ROX Index in Predicting Early Invasive Mechanical Ventilation in COVID-19. A Pragmatic, Retrospective, Multi-Center Study

The ability of COVID-19 to compromise the respiratory system has generated a substantial proportion of critically ill patients in need of invasive mechanical ventilation (IMV). The objective of this paper was to analyze the prognostic ability of the pulse oximetry saturation/fraction of inspired oxygen ratio (SpO2/FiO2) and the ratio of SpO2/FiO2 to the respiratory rate–ROX index–as predictors of IMV in an emergency department in confirmed COVID-19 patients. A multicenter, retrospective cohort study was carried out in four provinces of Spain between March and November 2020. The discriminative power of the predictive variable was assessed through a prediction model trained using a derivation sub-cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic (ROC) on the validation sub-cohort. A total of 2040 patients were included in the study. The IMV rate was 10.1%, with an in-hospital mortality rate of 35.3%. The performance of the SpO2/FiO2 ratio was better than the ROX index–AUC = 0.801 (95% CI 0.746–0.855) and AUC = 0.725 (95% CI 0.652–0.798), respectively. In fact, a direct comparison between AUCs resulted in significant differences (p = 0.001). SpO2 to FiO2 ratio is a simple and promising non-invasive tool for predicting risk of IMV in patients infected with COVID-19, and it is realizable in emergency departments.

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Effects of non-invasive mechanical ventilation (NIV) on the upper airway (UA) in patients with amyotrophic lateral sclerosis (ALS) and role of respiratory endoscopy in their assessment

10.1183/13993003.congress-2020.2952 ◽

2020 ◽

Author(s):

Mikel Sarasate Azkona ◽

Yuliana Pascual ◽

Eva Farrero ◽

Ana Cordoba ◽

Noelia Cubero De Frutos ◽

...

Keyword(s):

Mechanical Ventilation ◽

Amyotrophic Lateral Sclerosis ◽

Invasive Mechanical Ventilation ◽

Upper Airway ◽

Non Invasive ◽

Lateral Sclerosis

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ROLE OF NON-INVASIVE MECHANICAL VENTILATION (NIMV) IN SEVERE ACUTE HYPERCAPNIC RESPIRATORY FAILURE

CHEST Journal ◽

10.1378/chest.134.4_meetingabstracts.p122002 ◽

2008 ◽

Vol 134 (4) ◽

pp. 122P

Author(s):

Rohit Caroli ◽

Nitin Goel ◽

Hemant Kalra ◽

V.K. Vijayan

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Invasive Mechanical Ventilation ◽

Hypercapnic Respiratory Failure ◽

Non Invasive ◽

Acute Hypercapnic Respiratory Failure

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Intravenous immunoglobulin treatment for patients with severe COVID-19: a retrospective multi-center study

10.21203/rs.3.rs-52428/v1 ◽

2020 ◽

Author(s):

Jiao Liu ◽

Yizhu Chen ◽

Ranran Li ◽

Xuan Dong ◽

Yizhong Li ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intravenous Immunoglobulin ◽

Myocardial Injury ◽

Invasive Mechanical Ventilation ◽

Ivig Treatment ◽

High Dose ◽

Non Invasive ◽

Immunoglobulin Treatment ◽

Multi Center Study ◽

Center Study

Abstract Background: Intravenous immunoglobulin (IVIG) is commonly used to treat severe COVID-19, although the clinical outcomes remain unclear. This study evaluated the effectiveness of IVIG treatment for severe COVID-19.Methods: This retrospective multi-center study evaluated 28-day mortality and time for SARS-CoV-2 RNA clearance in severe COVID-19 patients with or without IVIG treatment. Propensity score matching was used to control confounding factors. Logistic regression and competing risk analyses were performed.Results: The study included 850 patients (421 patients received IVIG). No significant differences in 28-day mortality or time for SARS-CoV-2 RNA clearance were observed (p=0.357 and p=0.123, respectively). High-dose of IVIG treatment (>10 g/day) (n=27) was associated with decreased 28-day mortality (OR: 0.33, 95% CI: 0.14–0.77; p=0.011). The IVIG group had prolonged median hospitalization, less shock, and higher incidences of acute respiratory distress syndrome, myocardial injury. Furthermore, IVIG-treated patients were more likely to require non-invasive mechanical ventilation and less likely to require invasive mechanical ventilation.Conclusions: IVIG treatment for severe COVID-19 patients was not associated with significant improvements in 28-day mortality or time for SARS-CoV-2 RNA clearance. However, some improvements in 28-day survival were observed for high-dose IVIG treatment (>10 g/day).

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Effects of photobiomodulation therapy combined with static magnetic field (PBMT-sMF) in patients with severe COVID-19 requiring intubation: a pragmatic randomized placebo-controlled trial

10.1101/2020.12.02.20237974 ◽

2020 ◽

Author(s):

Thiago De Marchi ◽

Fabiano Frâncio ◽

João Vitor Ferlito ◽

Renata Monteiro Weigert ◽

Cristiane Aparecida de Oliveira ◽

...

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Primary Outcome ◽

Controlled Trial ◽

Invasive Mechanical Ventilation ◽

C Reactive Protein ◽

Reactive Protein ◽

Secondary Outcomes ◽

Fraction Of Inspired Oxygen ◽

Inspired Oxygen

ABSTRACTBackgroundPhotobiomodulation therapy (PBMT) when used isolated or combined with static magnetic field (PBMT-sMF) has been proven benefits on skeletal muscle increasing performance and reducing fatigue, increasing oxygen saturation, and modulating inflammatory process. However, it is unknown whether the effects observed with this therapy on respiratory muscles will be similar to the effects previously observed on skeletal muscles.ObjectiveWe aimed to investigate whether PBMT-sMF is able to decrease the length of stay in the intensive care unit (ICU) and to reduce the mortality rate of patients with severe COVID-19 requiring invasive mechanical ventilation, increasing the respiratory function and modulating the inflammatory process.MethodsWe conducted a prospectively registered, pragmatic, triple-blinded (patients, therapists and outcome assessors), randomized, placebo-controlled trial of PBMT-sMF in patients with severe COVID-19, requiring invasive mechanical ventilation, admitted to the ICU. Patients were randomly assigned to receive either PBMT-sMF (6 sites at the lower thorax – 189 J total, and 2 sites at the neck area – 63 J total) or placebo PBMT-sMF daily during all the ICU stay. The primary outcome was length of stay in the ICU defined by either discharge or death. The secondary outcomes were survival rate, muscle function of diaphragm, change in blood tests, change in mechanical ventilation parameters and change in arterial blood gas analysis.ResultsA total of 30 patients underwent randomization (with 15 assigned to PBMT-sMF and 15 to placebo) and were analyzed. The length of stay in the ICU for the placebo group was 23.06 days while for the PBMT-sMF group was 16.26. However, there was no statistically difference between groups for the length of stay in the ICU (mean difference - MD = - 6.80; 95% CI = - 18.71 to 5.11). Regarding the secondary outcomes were observed statistically differences in favor of PBMT-sMF for diaphragm thickness, fraction of inspired oxygen, partial pressure of oxygen/fraction of inspired oxygen ratio, C-reactive protein, lymphocytes count, and hemoglobin (p<0.05).ConclusionAmong patients with severe COVID-19 requiring invasive mechanical ventilation, PBMT-sMF was not statistically different than placebo to the length of stay in the ICU. However, it is important to highlight that our sample size was underpowered to detect statistical differences to the primary outcome. In contrast, PBMT-sMF increased muscle function of diaphragm, improved ventilatory parameters, decreased C-reactive protein levels and hemoglobin count, and increased lymphocytes count.

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