Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure

Vita, Nello De; Scotti, Lorenza; Cammarota, Gianmaria; Racca, Fabrizio; Pissaia, C; Maestrone, C; Colombo, Davide; Olivieri, Carlo; Corte, Francesco Della; Barone-Adesi, Francesco; Navalesi, Paolo; Vaschetto, Rosanna

doi:10.1016/j.pulmoe.2020.12.010

Cited by 41 publications

(43 citation statements)

References 28 publications

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“…We report better outcomes with HFNO including mortality, escalation, intubation rates (IMV) compared with CPAP with a confirmatory ROX index value similar to prior studies ,10,11,13,14 . More significantly, we report sensitivity of the ROX index in CPAP which indicates likely success from 2 hours with maximal sensitivity at 24 hours, confirming early signals from smaller studes 25,27 . HFNO and CPAP are used globally to manage the demand posed by the SARS-CoV-2 pandemic.…”

Section: Discussionsupporting

confidence: 74%

“…We provide an early positive report of the value of the ROX in CPAP, unlike the small studies in the past with 20 and 18 patients who report mixed results 11,25 . The ROX discriminates outcomes early from 1 hour onwards with the most sensitivity at 24 hours.…”

Section: Discussionmentioning

confidence: 67%

“…A benchmark for success of non-invasive respiratory support will enable easier comparison but has yet to emerge 24,25 . The ROX index, a ratio of oxygenation and respiratory rate, has been validated in SARS-CoV-2 for HFNO 10,11,13,14,26 .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the ROX index in SARS-CoV-2 Acute Respiratory failure treated with both High-Flow Nasal Oxygen (HFNO) and Continuous Positive Airway Pressure (CPAP)

Ghani

Shaw

Pyae

et al. 2021

Preprint

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Background: Non-invasive respiratory support including high-flow nasal oxygen (HFNO), and continuous positive airway pressure (CPAP) have been used to provide therapy in selected SARS-CoV-2 patients with acute respiratory failure (ARF). The value of the ROX index, a validated benchmark for outcomes in HFNO is unknown in CPAP. Objective: Can the ROX, a validated benchmark in HFNO be used for measuring treatment outcomes of CPAP in SARS-COV-2 ARF? Study Design and Methods: A non-randomised prospective protocol driven observational non-intensive care unit study in 130 SARS-COV-2 patients with ARF treated with non-invasive therapy from March 2020 to January 2021. The primary end point was failure of therapy (death or escalation). Secondary outcomes included time to failure including invasive mechanical ventilation (IMV) or death, the effect of escalation to CPAP from HFNO and the utility of ROX in ARF. Results: HFNO was better than CPAP in treating SARS-COV-2 ARF: 17/35 (48.5%) with successful HFNO therapy versus 24/95 (25.2%) with CPAP. The ROX index was more sensitive to outcomes with CPAP compared to HFNO and distinguished treatment failure early at 1, 4, 6, 12, and 24 hours with the highest sensitivity at 24 hours (ROX-24h). The AUC for the ROX-24h was 0.77 for HFNO (P<0.0001), and 0.84 for CPAP (P<0.0001). The ROX-24h cut-points predicted failure with HFNO when < 3.9 (PPV 71%, NPV 75%) and CPAP < 4.3 (PPV 75%, NPV 91%). For success, ROX-24h cut-points of 7.6 for HFNO (PPV 85%, NPV 48%) and 6.1 for CPAP (PPV 88%, NPV 62%) were observed. Escalation from HFNO to CPAP was mostly not successful. Conclusion: ARF in SARS-COV-2 can be successfully managed by non-invasive support. The ROX index, validated for HFNO, provides a timely, low resource measure for both HFNO and CPAP avoiding delayed intubation. Trial registration: Study approved by NHS HRAREC (20/HRA/2344;ethics 283888)

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 67%

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Evaluation of the ROX index in SARS-CoV-2 Acute Respiratory failure treated with both High-Flow Nasal Oxygen (HFNO) and Continuous Positive Airway Pressure (CPAP)

Ghani

Shaw

Pyae

et al. 2021

Preprint

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“…Older age has been partially associated with the high frequency of multiple comorbidities [ 25 ] but it was also an independent death risk factor [ 26 ]. Age was also defined as a predictor factor for intubation [ 27 ], however in Coronado study age was not a risk factor for orotracheal intubation and/or death on day 7 [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome and death risk of diabetes patients with Covid-19 receiving pre-hospital and in-hospital metformin therapies

Tamura

Said

Freitas

et al. 2021

Diabetol Metab Syndr

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Background COVID-19 has stroke Brazil harshly, deaths by COVID-19 in Brazil represent almost 13% of the total deaths by COVID-19 in the world, even though Brazilian population represents only 2.6% of the world population. Our aim in this study was to evaluate death and intubation outcomes and risk factors associated with COVID-19, and treatment options focusing on diabetes patients and the use of metformin pre-admission and during hospitalization. Methods In this Brazilian single-center study we evaluated 1170 patients hospitalized due to COVID-19. Diabetes patients (n = 188) were divided based on their use of pre-hospital and in-hospital metformin (non-met-group and met-group). Results In the total cohort most comorbidities were risk factors for orotracheal intubation and death. The use of chloroquine/hydroxychloroquine was significantly associated with increased death and intubation risk in uni- and multivariate analysis. Diabetes patients showed worst clinical feature compared with non-diabetes patients. In-hospital non-met-group had increased mortality (20.5%) compared to met-group (3.5%) (p = 0.0002) and univariable cox proportion hazard regression indicated in-hospital metformin reduced mortality (HR = 0.325, p = 0.035). Patients that used pre-hospital metformin showed lower severity parameters at hospital admission. (met-group: 2.45 ± 2.5; non-met-group: 4.25 ± 3.4). In all the groups older patients showed more severe clinical conditions and high risk of death and intubation. Conclusion Even though this is a single-center study, results from other reports have shown a similar trend, indicating that patients that used metformin during hospitalization have a better prognosis and reduced risk of death.

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“…Indicators of NIV failure could have substantial patient-level impact through clinical decision-making support [10]. Clinical factors related to NIV failure could be used to guide clinical decision-making.…”

Section: Potential Impact and Future Workmentioning

confidence: 99%

Phenotyping COVID-19 Patients by Ventilation Therapy: Data Quality Challenges and Cohort Characterization

Essay

Mosier

Subbian

2021

Studies in Health Technology and Informatics

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The COVID-19 pandemic introduced unique challenges for treating acute respiratory failure patients and highlighted the need for reliable phenotyping of patients using retrospective electronic health record data. In this study, we applied a rule-based phenotyping algorithm to classify COVID-19 patients requiring ventilatory support. We analyzed patient outcomes of the different phenotypes based on type and sequence of ventilation therapy. Invasive mechanical ventilation, noninvasive positive pressure ventilation, and high flow nasal insufflation were three therapies used to phenotype patients leading to a total of seven subgroups; patients treated with a single therapy (3), patients treated with either form of noninvasive ventilation and subsequently requiring intubation (2), and patients initially intubated and then weaned onto a noninvasive therapy (2). In addition to summary statistics for each phenotype, we highlight data quality challenges and importance of mapping to standard terminologies. This work illustrates potential impact of accurate phenotyping on patient-level and system-level outcomes including appropriate resource allocation under resource constrained circumstances.

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Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure

Cited by 41 publications

References 28 publications

Evaluation of the ROX index in SARS-CoV-2 Acute Respiratory failure treated with both High-Flow Nasal Oxygen (HFNO) and Continuous Positive Airway Pressure (CPAP)

Evaluation of the ROX index in SARS-CoV-2 Acute Respiratory failure treated with both High-Flow Nasal Oxygen (HFNO) and Continuous Positive Airway Pressure (CPAP)

Outcome and death risk of diabetes patients with Covid-19 receiving pre-hospital and in-hospital metformin therapies

Phenotyping COVID-19 Patients by Ventilation Therapy: Data Quality Challenges and Cohort Characterization

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