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. 2021 Mar 5;9(1):23.
doi: 10.1186/s40560-021-00538-8.

Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study

Ricard Mellado-Artigas  1 , Luis Eduardo Mujica  2 , Magda Liliana Ruiz  2 , Bruno Leonel Ferreyro  3 , Federico Angriman  3   4 , Egoitz Arruti  5 , Antoni Torres  6   7 , Enric Barbeta  6 , Jesús Villar  7   8   9 , Carlos Ferrando  10   7 ; COVID-19 Spanish ICU Network
Collaborators, Affiliations

Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study

Ricard Mellado-Artigas et al. J Intensive Care. .

Abstract

Purpose: We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation.

Methods: This is a multicenter, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated.

Results: From a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.41-2.35], and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53; 95% CI: 0.37-0.72), and pH (OR 0.47; 95% CI: 0.24-0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95% CI 0.80-0.96).

Conclusions: Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.

Keywords: COVID-19; High-flow nasal oxygen therapy; Hypoxemic respiratory failure; Invasive mechanical ventilation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient flowchart. Two hundred fifty-nine patients were included and followed up until ICU discharge or death. NIV, non-invasive ventilation; IMV, mechanical ventilation
Fig. 2
Fig. 2
ROC curve in the validation dataset. AUC, area under the curve. The black dot on the ROC curve depicts the optimal threshold, as defined as the probability cut-off with the best accuracy
See this image and copyright information in PMC

References

    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed
    1. Karagiannidis C, Mostert C, Hentschker C, et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med. 2020;0(0). doi:10.1016/S2213-2600(20)30316-7 - PMC - PubMed
    1. Bellani G, Laffey JG, Pham T, et al. Noninvasive ventilation of patients with acute respiratory distress syndrome: insights from the LUNG SAFE Study. Am J Respir Crit Care Med. 2017;195(1):67–77. doi: 10.1164/rccm.201606-1306OC. - DOI - PubMed
    1. Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy. JAMA. 2020;323(16):1545. doi: 10.1001/jama.2020.4031. - DOI - PubMed
    1. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574–1581. doi: 10.1001/jama.2020.5394. - DOI - PMC - PubMed

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