Strategies for monitoring and predicting failure to high-flow nasal cannula therapy in the ED

Gallardo, Adrián; Gigliotti, Cinthia; Saavedra, Santiago; Zamarrón-López, Eder Iván; Guerrero-Gutiérrez, Manuel Alberto; Pérez‐Nieto, Orlando Rubén

doi:10.1016/j.ajem.2021.12.046

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…The ROX index is frequently utilized as a promising instrument for detecting failure of HFNC treatment in COVID-19 pneumonia individuals [12,22]. As per a meta-analysis, the ROX index within 24 h after admission with a cut-off value of 5.0 might predict HFNC failure with a sensitivity of 70.0% and a specificity of 79.0% [23].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study

et al. 2022

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Background and Objective: Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The goals of this prospective observational research were to estimate predictive factors for HFNC and NIV failure in COVID-19-related AHRF subjects. Materials and Methods: The research enlisted the participation of 124 patients. A stepwise treatment approach was used. HFNC and NIV were used on 124 (100%) and 64 (51.6%) patients, respectively. Thirty (24.2%) of 124 patients were intubated and received invasive mechanical ventilation. Results: 85 (68.5%) patients were managed successfully. Patients who required NIV exhibited a higher prevalence of treatment failure (70.3% vs. 51.6%, p = 0.019) and had higher mortality (59.4% vs. 31.5%, p = 0.001) than patients who received HFNC. Using logistic regression, the respiratory rate oxygenation (ROX) index at 24h (odds ratio (OR) = 0.74, p = 0.018) and the Charlson Comorbidity Index (CCI) (OR = 1.60, p = 0.003) were found to be predictors of HFNC efficacy. It was the ROX index at 24 h and the CCI optimum cut-off values for HFNC outcome that were 6.1 (area under the curve (AUC) = 0.73) and 2.5 (AUC = 0.68), respectively. Serum ferritin level (OR = 0.23, p = 0.041) and lymphocyte count (OR = 1.03, p = 0.01) were confirmed as predictors of NIV failure. Serum ferritin level at a cut-off value of 456.2 ng/mL (AUC = 0.67) and lymphocyte count lower than 0.70 per mm3, (AUC = 0.70) were associated with NIV failure with 70.5% sensitivity, 68.7% specificity and sensitivity of 84.1%, specificity of 56.2%, respectively. Conclusion: The ROX index at 24 h, CCI, as well as serum ferritin level, and lymphocyte count can be used as markers for HFNC and NIV failure, respectively, in SARS-CoV-2-induced AHRF patients.

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Section: Discussionmentioning

confidence: 99%

Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study

et al. 2022

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“…Existen múltiples estrategias de monitorización, la mayoría basadas en índices o parámetros clínicos fáciles de evaluar. 87 (Tabla 1).…”

Section: Monitorizaciónunclassified

Cánula nasal de alto flujo en pacientes críticos: una revisión narrativa

Gallardo

Dévoli²,

Gigliotti

et al. 2023

Respirar

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La cánula nasal de alto flujo se ha convertido en una de las principales estrategias de soporte ventilatorio no invasivo en la insuficiencia respiratoria aguda hipoxémica, principalmente después de la pandemia de COVID-19. Sin embargo, su uso se extiende más allá de este escenario y abarca diferentes condiciones clínicas como el período postextubación, período postquirúrgico, insuficiencia respiratoria hipercápnica y soporte vital en pacientes inmunodeprimidos, trasplantados u oncológicos. Los manuscritos que avalan su aplicación han sido ampliamente difundidos y el grado de evidencia es lo suficientemente alto como para recomendar su uso. Por tanto, es necesario destacar sus efectos fisiológicos como el confort, una fracción inspirada de oxígeno precisa, el lavado de CO 2 o la optimización del volumen pulmonar de fin de espiración para comprender su mecanismo de acción y mejorar los resultados de los pacientes.El objetivo de esta revisión narrativa es ofrecer un resumen breve y conciso de los efectos y beneficios de aplicar esta terapia en diferentes escenarios clínicos sin la estructura rígida de una revisión sistemática. Con base en estas líneas, el lector curioso puede ampliar la evidencia científica que avala el empleo de la cánula nasal de alto flujo en cada escenario particular.Palabras clave: cánula nasal de alto flujo, efectos, beneficios, riesgos potenciales.

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“…They designed their study to switch over to non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV) as rescue therapy in the case of deterioration of patients when patients were treated with HFNO with a flow rate of < 50 l/min Increasing the flow rate would have achieved better outcomes. 3 , 4 A study reported a positive linear relationship between the amount of delivered flow and the generated mean airway pressure. 5 For every 10 l/min increase in gas flow, the generated mean airway pressure can increase by approximately 1.16 cm H 2 O.…”

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confidence: 99%

Comment on "Dynamic Assessment of the ROX Index as a Predictive Tool During High-flow Nasal Oxygen Therapy: Underpinning Facts"

Goswami¹,

Bhattacharya²,

Mandal³

et al. 2023

Balkan Med J

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Strategies for monitoring and predicting failure to high-flow nasal cannula therapy in the ED

Cited by 5 publications

References 14 publications

Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study

Predictors of Noninvasive Respiratory Support Failure in COVID-19 Patients: A Prospective Observational Study

Cánula nasal de alto flujo en pacientes críticos: una revisión narrativa

Comment on "Dynamic Assessment of the ROX Index as a Predictive Tool During High-flow Nasal Oxygen Therapy: Underpinning Facts"

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