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. 2021 Dec 29;11(1):179.
doi: 10.3390/jcm11010179.

Single-Breath Counting Test Predicts Non-Invasive Respiratory Support Requirements in Patients with COVID-19 Pneumonia

Yaroslava Longhitano  1   2   3 , Christian Zanza  1   2   3   4 , Tatsiana Romenskaya  1 , Angela Saviano  4 , Tonia Persiano  5 , Mirco Leo  1 , Andrea Piccioni  4 , Marta Betti  6 , Antonio Maconi  6 , Ivano Pindinello  7 , Riccardo Boverio  5 , Jordi Rello  8   9 , Francesco Franceschi  4 , Fabrizio Racca  1
Affiliations

Single-Breath Counting Test Predicts Non-Invasive Respiratory Support Requirements in Patients with COVID-19 Pneumonia

Yaroslava Longhitano et al. J Clin Med. .

Abstract

The use of non-invasive respiratory strategies (NIRS) is crucial to improve oxygenation in COVID-19 patients with hypoxemia refractory to conventional oxygen therapy. However, the absence of respiratory symptoms may delay the start of NIRS. The aim of this study was to determine whether a simple bedside test such as single-breath counting test (SBCT) can predict the need for NIRS in the 24 h following the access to Emergency Department (ED). We performed a prospective observational study on 120 patients with COVID-19 pneumonia. ROC curves were used to analyze factors which might predict NIRS requirement. We found that 36% of patients had normal respiratory rate and did not experience dyspnea at rest. 65% of study population required NIRS in the 24 h following the access to ED. NIRS-requiring group presented lower PaO2/FiO2 (235.09 vs. 299.02), SpO2/FiO2 ratio (357.83 vs. 431.07), PaCO2 (35.12 vs. 40.08), and SBCT (24.46 vs. 30.36) and showed higher incidence of dyspnea at rest (57.7% vs. 28.6%). Furthermore, SBCT predicted NIRS requirement even in the subgroup of patients without respiratory symptoms (AUC = 0.882, cut-off = 30). SBCT might be a valuable tool for bedside assessment of respiratory function in patients with COVID-19 pneumonia and might be considered as an early clinical sign of impending respiratory deterioration.

Keywords: COVID-19; continuous positive airway pressure (CPAP); high-flow nasal cannula; pneumonia; single breath count.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ROC curve analysis of PaO2/FiO2 (a), SBCT (b), Respiratory Rate (c) and SpO2/FiO2 (d) as predictors of NIRS requirement. Tests performed in all included patients. Abbreviations: NIRS, non-invasive respiratory strategies; SBCT, single-breath counting test.
Figure 2
Figure 2
ROC curve analysis of SBCT performance in predicting NIRS requirement in the subgroup of patients with normal respiratory rate and absence of dyspnea at rest. Abbreviations: NIRS, non-invasive respiratory strategies; SBCT, single-breath counting test.
See this image and copyright information in PMC

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