Validity of a clinical scale in predicting the failure of non-invasive ventilation in hypoxemic patients

Carrillo, Andrés; Lopez, Antonia; Carrillo, Luna; Caldeira, Vânia; Guia, Miguel; Alonso, Núria; Renedo, A. Arnaiz; Quintana, María Elena Martínez; Sánchez, Javier; Esquinas, António M.

doi:10.1016/j.jcrc.2020.08.008

Cited by 26 publications

(25 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently Carrillo et al [ 16 ] conducted a study to analyze the validity of the HACOR score, retrospectively enrolling 2711 patients in 2749 episodes of hypoxemic ARF requiring NIV. They confirmed the accuracy of the HACOR score, particularly in pneumonia and ARDS.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Guia

Boléo-Tomé

Imitazione

et al. 2021

Respiratory Medicine

Self Cite

View full text Add to dashboard Cite

Introduction In COVID-19 associated hypoxemic acute respiratory failure (ARF) without mandatory indication for urgent endotracheal intubation, a trial of CPAP may be considered. We aimed to evaluate HACOR (heart rate, acidosis, consciousness, oxygenation, respiratory rate) score performance in these patients as predictor of CPAP failure. Methods Prospective observational multicentric study (three centers in different countries), including adult patients with SARS-CoV-2 pneumonia admitted to a respiratory intermediate care unit, presenting PaO 2 /FiO 2 < 300 and PaCO 2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated. Results We enrolled 128 patients, mean age 61,7 years. Mean HACOR at one hour after starting CPAP was 3,27 ± 3,84 and mean PaO 2 /FiO 2 was 203,30 ± 92,21 mmHg; 35 patients (27,3%) presented CPAP failure: 29 underwent oro-tracheal intubation and 6 died due to COVID-19 (all having a do-not-intubate order). HACOR accuracy for predicting CPAP failure was 82,03%, while PaO 2 /FiO2 accuracy was 81,25%. Conclusion Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO 2 /FiO 2 has also shown to be a good predictor of failure.

show abstract

Section: Discussionmentioning

confidence: 99%

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Guia

Boléo-Tomé

Imitazione

et al. 2021

Respiratory Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“… 78 Several scores have been proposed for AHRF, but none has been validated yet in COVID-19. A useful method to apply at bedside for identifying AHRF patients at risk of non-invasive support failure is the HACOR score, 111 currently under investigation in the specific setting of COVID-19. 112 This score includes heart rate, pHa, Glasgow Coma Scale (GCS), PaO 2 /FiO 2 , and respiratory rate, and should be calculated after 1 hour of non-invasive support.…”

Section: How Can P-sili Be Prevented?mentioning

confidence: 99%

“…Attention should also be paid to the degree of hypoxemia and its effects on peripheral organs, since COVID-19 is characterized by multiple organ involvement. 1 11 …”

Section: Introductionmentioning

confidence: 99%

Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review

Battaglini

Robba

Ball

et al. 2021

British Journal of Anaesthesia

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) pneumonia is associated with hypoxemic respiratory failure, ranging from mild to severe. Due to the worldwide shortage of intensive care unit beds, a relatively high number of patients with respiratory failure are receiving prolonged non-invasive respiratory support, even when their clinical status would have required invasive mechanical ventilation. There are few experimental and clinical data reporting that vigorous breathing effort during spontaneous ventilation can worsen lung injury and cause a phenomenon that has been termed patient self-inflicted lung injury (P-SILI). The aim of this narrative review is to provide an overview of P-SILI pathophysiology and the role of non-invasive respiratory support in COVID-19 pneumonia. Respiratory mechanics, vascular compromise, viscoelastic properties, lung inhomogeneity, work of breathing, and oesophageal pressure swings are discussed. The concept of P-SILI has been widely investigated in recent years, but controversies persist regarding its mechanisms. To minimize the risk of P-SILI, intensivists should better understand its underlying pathophysiology to optimize the type of non-invasive respiratory support provided to patients with COVID-19 pneumonia, as well as decide on the optimal timing of intubation for these patients.

show abstract

“…In our study, the discriminative capacity of the HACOR scale was similar to that reported by Innocenti et al (AUROC of 0.68). (20) but it was lower than that found by Duan et al, (AUROC of 0.89) (9) and Carrillo et al (AUROC of 0.88) (11). We believe that these differences occurred because in the studies by Duan et al, and Carrillo et al Patients with respiratory failure secondary to causes other than COVID19 infection, as well as patients with hypercapnic respiratory failure, were taken.…”

Section: Discussionmentioning

confidence: 70%

“…According to the recommendations of the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis statement (TRIPOD) (11), the minimum sample size was 100 events and 100 not events, so a minimum of 100 failures to the HFNC was sought. The baseline characteristics were compared between the treatment groups with the use of chi-square and Wilcoxon tests.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Discrimination Capacity of the ROX and HACOR Scales to Predict High-flow Nasal Cannula Failure in Patients With SARS-CoV-2 Pneumonia

Lucero

Valencia

Castro

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundThe pandemic of SARSCov2 infection has created a challenge in health services worldwide. Some scales have been applied to evaluate the risk of intubation, such as the ROX and HACOR. The objective of this study is to compare the predictive capacity of the HACOR scale and the ROX index and define the optimal cut-off points.MethodsStudy of diagnostic tests based on a retrospective cohort. Composite outcome was the proportion of patients that needed orotracheal intubation or died of COVID19 pneumonia. Discrimination capacity was compared by the area under the curve of each of the two scales and the optimal cut-off point was determined using the Liu method.Results245 patients were included, of which 140 (57.14%) required OTI and 152 (62.04%) had the composite end result of HFNC failure. The discrimination capacity was similar for the two scales with an AUROC of 0.71 and 0.72 for the HACOR scale for the ROX index, respectively. The optimal cut-off point for the ROX index was 5.62 (sensitivity 62% specificity 65%), while the optimal cut-off point for the HACOR scale was 5.5 (sensitivity 66% specificity 65%).ConclusionsThe HACOR scale and the ROX index have a moderate predictive capacity to predict failures to the HFNC strategy. They can be used in conjunction with other clinical variables to define which patients may require invasive mechanical ventilation.

show abstract

Validity of a clinical scale in predicting the failure of non-invasive ventilation in hypoxemic patients

Cited by 26 publications

References 25 publications

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review

Comparison of the Discrimination Capacity of the ROX and HACOR Scales to Predict High-flow Nasal Cannula Failure in Patients With SARS-CoV-2 Pneumonia

Contact Info

Product

Resources

About