Comparison of ROX and HACOR scales to predict high-flow nasal cannula failure in patients with SARS-CoV-2 pneumonia

Valencia, Carlos; Lucero, Oscar; Castro, Onofre Casas; Sanko, Andrey Alexandrovich; Olejua, Peter

doi:10.1038/s41598-021-02078-5

Cited by 30 publications

(28 citation statements)

References 29 publications

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“…Second, regarding the utility of the ROX index, the authors contradicted the results of a recent meta-analysis ( 2 ). For Burnim et al ( 1 ), this index performed poorly, as recently reported in another cohort ( 3 ). The authors performed an additional model including “demographic, clinical, and laboratory variables” and found a better predictor of IMV.…”

Section: To the Editormentioning

confidence: 56%

High-Flow Nasal Cannula in COVID-19 Pneumonia: Practical Issues

Laserna

Barahona-Correa

Papadakos

et al. 2022

Critical Care Medicine

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We read with great interest the study by Burnim et al (1), recently published in Critical Care Medicine, in which authors conducted a retrospective review of 504 patients with severe COVID-19 treated with high-flow nasal cannula (HFNC). The authors concluded that HFNC was associated with a paradoxically longer median time to discharge and was not associated with a mortality benefit; however, a secondary analysis showed a reduction of the hazard of death at 28 days among patients not mechanically ventilated within 6 hours of admission. In addition, the authors reported a poor performance of the rate-oxygenation index (ROX) to predict progression to invasive mechanical ventilation (IMV) (1).Although this study contributes to existing literature on HFNC, we consider some aspects worthy of discussion. First, although the authors focused on hospital discharge, it would have been interesting to know the effect of the intervention in ICU outcomes, such as ICU length of stay (LOS), ICU mortality, days of mechanical ventilation, and the need of tracheostomy, among others, and how these ICU outcomes affected hospital LOS. Second, regarding the utility of the ROX index, the authors contradicted the results of a recent meta-analysis (2). For Burnim et al (1), this index performed poorly, as recently reported in another cohort (3). The authors performed an additional model including "demographic, clinical, and laboratory variables" and found a better predictor of IMV. It would be useful to know what variables were included to be able to replicate the findings in retrospective and prospective studies.Finally, it is essential to highlight that retrospective studies during the COVID-19 pandemic are at risk of being affected by a cohort effect given rapid and constant treatment changes, a better understanding of the disease, and new interventions over time. The authors addressed this point by matching patients according to whether they were admitted before or after June 1, 2020, when the evidence of mortality benefit of glucocorticoids use came to light (4). Nonetheless, other clinical interventions, such as conscious pronation, muscle paralysis, or other immunomodulation strategies, should have been considered. These factors are particularly relevant as several clinical trials were recruiting patients from the Johns Hopkins health system during the inclusion period (5). These interventions may have influenced the mortality effect estimate and the assumption of a stable hazard ratio between the groups throughout follow-up; this secondary analysis can be explored in another study with the same population.In summary, Burnim et al (1) provide relevant information about the use of HFNC in a big cohort of COVID-19 patients. Although some details would have been interesting to know regarding this sample population, the study suggests that HFNC may be associated with a 28-day mortality benefit in appropriately

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Section: To the Editormentioning

confidence: 56%

High-Flow Nasal Cannula in COVID-19 Pneumonia: Practical Issues

Laserna

Barahona-Correa

Papadakos

et al. 2022

Critical Care Medicine

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“…In 128 hypoxemic patients with COVID-19 undergoing CPAP, Guia et al observed that a HACOR score > 5 was associated with an increased risk of CPAP failure [ 11 ], defined as the need for intubation or death. In a retrospective cohort of patients with COVID-19-related pneumonia undergoing respiratory support with high flow nasal cannula, Valencia et al [ 12 ] found that the HACOR score predicted the need for intubation or death, with an optimal cut-off point of 5.5 [ 12 ]. As in previous studies, we found an association between a high 1-h HACOR score (i.e., >5) and the occurrence of either need for intubation or in-hospital death, after adjustment for confounders.…”

Section: Discussionmentioning

confidence: 99%

“…The utility of the HACOR score (measured 1 h after NIRS initiation) in patients with COVID 19-related ARF, has been investigated by Guia et al [ 11 ]; they observed a good performance of a HACOR score > 5 in predicting Continue Positive Airway Pressure (CPAP) failure, defined as the need for orotracheal intubation or death in COVID-19-related ARF [ 11 ]. Valencia et al [ 12 ] found a moderate capacity of the HACOR score to predict the failure (i.e., need for mechanical ventilation and death) of high flow nasal cannula treatment in patients with COVID-19 pneumonia. Whether an early determination of the HACOR score (i.e., calculated before the initiation of NIRS treatment) might be useful for predicting unfavorable in-hospital prognosis, has not been clarified.…”

Section: Introductionmentioning

confidence: 99%

The HACOR Score Predicts Worse in-Hospital Prognosis in Patients Hospitalized with COVID-19

Mannarino

Bianconi

Cosentini

et al. 2022

JCM

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Non-invasive respiratory support (NIRS) is widely used in COVID-19 patients, although high rates of NIRS failure are reported. Early detection of NIRS failure and promptly defining the need for intubation are crucial for the management of patients with acute respiratory failure (ARF). We tested the ability of the HACOR score¸ a scale based on clinical and laboratory parameters, to predict adverse outcomes in hospitalized COVID-19 patients with ARF. Four hundred patients were categorized according to high (>5) or low (≤5) HACOR scores measured at baseline and 1 h after the start of NIRS treatment. The association between a high HACOR score and either in-hospital death or the need for intubation was evaluated. NIRS was employed in 161 patients. Forty patients (10%) underwent intubation and 98 (25%) patients died. A baseline HACOR score > 5 was associated with the need for intubation or in-hospital death in the whole population (HR 4.3; p < 0.001), in the subgroup of patients who underwent NIRS (HR 5.2; p < 0.001) and in no-NIRS subgroup (HR 7.9; p < 0.001). In the NIRS subgroup, along with the baseline HACOR score, also 1-h HACOR score predicted NIRS failure (HR 2.6; p = 0.039). In conclusion, the HACOR score is a significant predictor of adverse clinical outcomes in patients with COVID-19-related ARF.

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“…Additionally, comorbidities such as hypertension and chronic kidney disease as well as bacterial co-infections may predict worse treatment outcomes 68 .…”

Section: Poor Prognosis Scoresmentioning

confidence: 99%

The RICU during the COVID Pandemic

Landete¹,

Terán-Tinedo²

2022

BRN

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The respiratory intermediate care unit (RICU) is logistically a «step up» or «step down» unit between the intensive care unit (ICU) and general hospitalization. It is efficiency in terms of «avoided cost». During the pandemic, RICU increased exponentially with the aim of avoiding ICU congestion with coronavirus disease 2019 (COVID-19) patients. These units must be attended by a multidisciplinary professional team with presence and assistance 24 hours a day and must be prepared with adequate monitoring for a quick scale in case of deterioration. The high flow nasal cannula (HFNC) increases ventilator-free days and reduces hospital stays. Awake prone position significantly reduced the incidence of treatment failure. Conscious sedation is used to increase the tolerance to non-invasive ventilation (NIV). In the treatment with HFNC, obesity, immunosuppression and elevated inflammatory markers were associated with a higher failure rate. With everything learned so far, there should be no hospital without RICU.

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Comparison of ROX and HACOR scales to predict high-flow nasal cannula failure in patients with SARS-CoV-2 pneumonia

Cited by 30 publications

References 29 publications

High-Flow Nasal Cannula in COVID-19 Pneumonia: Practical Issues

High-Flow Nasal Cannula in COVID-19 Pneumonia: Practical Issues

The HACOR Score Predicts Worse in-Hospital Prognosis in Patients Hospitalized with COVID-19

The RICU during the COVID Pandemic

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