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

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  • dc.contributor.author Mellado Artigas, Ricard
  • dc.contributor.author Mujica, Luis Eduardo
  • dc.contributor.author Ruiz, Magda Liliana
  • dc.contributor.author Ferreyro, Bruno Leonel
  • dc.contributor.author Angriman, Federico
  • dc.contributor.author Arruti, Egoitz
  • dc.contributor.author Torres, Antoni
  • dc.contributor.author Barbeta, Enric
  • dc.contributor.author Villar, Jesús
  • dc.contributor.author Ferrando, Carlos
  • dc.contributor.author COVID-19 Spanish ICU Network
  • dc.date.accessioned 2022-10-06T05:44:06Z
  • dc.date.available 2022-10-06T05:44:06Z
  • dc.date.issued 2021
  • dc.description.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.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Mellado-Artigas R, Mujica LE, Ruiz ML, Ferreyro BL, Angriman F, Arruti E, Torres A, Barbeta E, Villar J, Ferrando C; COVID-19 Spanish ICU Network. Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study. J Intensive Care. 2021 Mar 5;9(1):23. DOI: 10.1186/s40560-021-00538-8
  • dc.identifier.doi http://dx.doi.org/10.1186/s40560-021-00538-8
  • dc.identifier.issn 2052-0492
  • dc.identifier.uri http://hdl.handle.net/10230/54277
  • dc.language.iso eng
  • dc.publisher BioMed Central
  • dc.relation.ispartof J Intensive Care. 2021 Mar 5;9(1):23
  • dc.rights © The Author(s). 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.keyword COVID-19
  • dc.subject.keyword High-flow nasal oxygen therapy
  • dc.subject.keyword Hypoxemic respiratory failure
  • dc.subject.keyword Invasive mechanical ventilation
  • dc.title Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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Articles (Hospital del Mar Research Institute)