Abhimanyu Chandel1, Saloni Patolia2, A Whitney Brown3, A Claire Collins4, Dhwani Sahjwani5, Vikramjit Khangoora3, Paula C Cameron6, Mehul Desai7, Aditya Kasarabada6, Jack K Kilcullen6, Steven D Nathan3, Christopher S King3. 1. Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, Maryland. abhimanyu.chandel.mil@mail.mil. 2. Virginia Commonwealth University School of Medicine, Richmond, Virginia. 3. Department of Advanced Lung Disease and Transplant, Inova Fairfax Hospital, Falls Church, Virginia. 4. Advanced Lung Disease Research, Inova Fairfax Hospital, Falls Church, Virginia. 5. Department of Pediatrics, Inova Fairfax Hospital, Falls Church, Virginia. 6. Respiratory Therapy, Inova Fairfax Hospital, Falls Church, Virginia. 7. Medical Critical Care Service, Inova Fairfax Hospital, Falls Church, Virginia.
Abstract
BACKGROUND: Optimal timing of mechanical ventilation in COVID-19 is uncertain. We sought to evaluate outcomes of delayed intubation and examine the ROX index (ie, [[Formula: see text]]/breathing frequency) to predict weaning from high-flow nasal cannula (HFNC) in patients with COVID-19. METHODS: We performed a multicenter, retrospective, observational cohort study of subjects with respiratory failure due to COVID-19 and managed with HFNC. The ROX index was applied to predict HFNC success. Subjects that failed HFNC were divided into early HFNC failure (≤ 48 h of HFNC therapy prior to mechanical ventilation) and late failure (> 48 h). Standard statistical comparisons and regression analyses were used to compare overall hospital mortality and secondary end points, including time-specific mortality, need for extracorporeal membrane oxygenation, and ICU length of stay between early and late failure groups. RESULTS: 272 subjects with COVID-19 were managed with HFNC. One hundred sixty-four (60.3%) were successfully weaned from HFNC, and 111 (67.7%) of those weaned were managed solely in non-ICU settings. ROX index >3.0 at 2, 6, and 12 hours after initiation of HFNC was 85.3% sensitive for identifying subsequent HFNC success. One hundred eight subjects were intubated for failure of HFNC (61 early failures and 47 late failures). Mortality after HFNC failure was high (45.4%). There was no statistical difference in hospital mortality (39.3% vs 53.2%, P = .18) or any of the secondary end points between early and late HFNC failure groups. This remained true even when adjusted for covariates. CONCLUSIONS: In this retrospective review, HFNC was a viable strategy and mechanical ventilation was unecessary in the majority of subjects. In the minority that progressed to mechanical ventilation, duration of HFNC did not differentiate subjects with worse clinical outcomes. The ROX index was sensitive for the identification of subjects successfully weaned from HFNC. Prospective studies in COVID-19 are warranted to confirm these findings and to optimize patient selection for use of HFNC in this disease.
BACKGROUND: Optimal timing of mechanical ventilation in COVID-19 is uncertain. We sought to evaluate outcomes of delayed intubation and examine the ROX index (ie, [[Formula: see text]]/breathing frequency) to predict weaning from high-flow nasal cannula (HFNC) in patients with COVID-19. METHODS: We performed a multicenter, retrospective, observational cohort study of subjects with respiratory failure due to COVID-19 and managed with HFNC. The ROX index was applied to predict HFNC success. Subjects that failed HFNC were divided into early HFNC failure (≤ 48 h of HFNC therapy prior to mechanical ventilation) and late failure (> 48 h). Standard statistical comparisons and regression analyses were used to compare overall hospital mortality and secondary end points, including time-specific mortality, need for extracorporeal membrane oxygenation, and ICU length of stay between early and late failure groups. RESULTS: 272 subjects with COVID-19 were managed with HFNC. One hundred sixty-four (60.3%) were successfully weaned from HFNC, and 111 (67.7%) of those weaned were managed solely in non-ICU settings. ROX index >3.0 at 2, 6, and 12 hours after initiation of HFNC was 85.3% sensitive for identifying subsequent HFNC success. One hundred eight subjects were intubated for failure of HFNC (61 early failures and 47 late failures). Mortality after HFNC failure was high (45.4%). There was no statistical difference in hospital mortality (39.3% vs 53.2%, P = .18) or any of the secondary end points between early and late HFNC failure groups. This remained true even when adjusted for covariates. CONCLUSIONS: In this retrospective review, HFNC was a viable strategy and mechanical ventilation was unecessary in the majority of subjects. In the minority that progressed to mechanical ventilation, duration of HFNC did not differentiate subjects with worse clinical outcomes. The ROX index was sensitive for the identification of subjects successfully weaned from HFNC. Prospective studies in COVID-19 are warranted to confirm these findings and to optimize patient selection for use of HFNC in this disease.
Authors: Filippo Cattazzo; Francesco Inglese; Andrea Dalbeni; Salvatore Piano; Martino Francesco Pengo; Martina Montagnana; Davide Dell'Atti; Francesco Soliani; Andrea Cascella; Stefano Vicini; Carmine Gambino; Pietro Minuz; Roberto Vettor; Gianfranco Parati; Paolo Angeli; Cristiano Fava Journal: Intern Emerg Med Date: 2022-01-28 Impact factor: 5.472
Authors: Sergey N Avdeev; Andrey I Yaroshetskiy; Galia S Nuralieva; Zamira M Merzhoeva; Natalia V Trushenko Journal: Am J Emerg Med Date: 2021-07-28 Impact factor: 4.093