Stratifying risk outcomes among adult COVID-19 inpatients with high flow oxygen: The R4 score

Aguirre-García, Gloria Mayela; Ramonfaur, Diego; Torre‐Amione, Guillermo; Ramírez-Elizondo, María Teresa; Lara-Medrano, Reynaldo; Moreno-Hoyos, J.F.; Velázquez-Ávila, E.S.; Diaz-Garza, Carlos A.; Sánchez-Nava, Victor M; Castilleja‐Leal, Fernando; Rhoades, G.M.; Martínez‐Reséndez, Michel F.

doi:10.1016/j.pulmoe.2021.10.001

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…After full-text assessment, 343 studies were excluded due to inappropriate study design, no relevant outcome, unavailable full-text, pre-prints, irrelevance to research question, model performance not reported, or studies including human participants under 18 years. After examining full-texts, we identified 314 eligible articles, of which 152 (48.4%) presented mortality as the outcome [ 4 , 5 , 12 – 160 ], 66 (21.0%) concentrated on severity and/or critical illness [ 2 , 161 – 225 ], 35 (11.1%) presented ICU admission and mortality combined [ 7 , 226 – 259 ], 17 (5.4%) assessed ICU admission only [ 225 , 260 – 275 ], 6 (1.9%) looked at mechanical ventilation only [ 276 – 281 ] and 38 (12.1%) assessed multiple combined outcomes [ 195 , 282 – 318 ]. We present the results in the PRISMA flow chart Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Six (1.9%) of 314 studies reported models predicted MV only [ 195 , 282 – 318 ], and 38 (12.1%) reported on a combination of outcomes (intubation, HFNT, ECMO, ICU admission and mortality) [ 195 , 282 – 318 ]. Prediction time defined as timeframe which the model pre-specified to assess its performance, i.e., from admission to event outcomes, was different across studies, and the longest time of follow-up here was 30 days.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic models in COVID-19 infection that predict severity: a systematic review

et al. 2023

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Current evidence on COVID-19 prognostic models is inconsistent and clinical applicability remains controversial. We performed a systematic review to summarize and critically appraise the available studies that have developed, assessed and/or validated prognostic models of COVID-19 predicting health outcomes. We searched six bibliographic databases to identify published articles that investigated univariable and multivariable prognostic models predicting adverse outcomes in adult COVID-19 patients, including intensive care unit (ICU) admission, intubation, high-flow nasal therapy (HFNT), extracorporeal membrane oxygenation (ECMO) and mortality. We identified and assessed 314 eligible articles from more than 40 countries, with 152 of these studies presenting mortality, 66 progression to severe or critical illness, 35 mortality and ICU admission combined, 17 ICU admission only, while the remaining 44 studies reported prediction models for mechanical ventilation (MV) or a combination of multiple outcomes. The sample size of included studies varied from 11 to 7,704,171 participants, with a mean age ranging from 18 to 93 years. There were 353 prognostic models investigated, with area under the curve (AUC) ranging from 0.44 to 0.99. A great proportion of studies (61.5%, 193 out of 314) performed internal or external validation or replication. In 312 (99.4%) studies, prognostic models were reported to be at high risk of bias due to uncertainties and challenges surrounding methodological rigor, sampling, handling of missing data, failure to deal with overfitting and heterogeneous definitions of COVID-19 and severity outcomes. While several clinical prognostic models for COVID-19 have been described in the literature, they are limited in generalizability and/or applicability due to deficiencies in addressing fundamental statistical and methodological concerns. Future large, multi-centric and well-designed prognostic prospective studies are needed to clarify remaining uncertainties.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Prognostic models in COVID-19 infection that predict severity: a systematic review

et al. 2023

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“…Since the beginning of the COVID-19 pandemic, many primary studies have explored clinical, service and safety outcomes associated with HFNC in patients with COVID-19 (10–32). Many of these studies are observational [ 10 , 11 ) and possess methodological weaknesses [ 12 – 21 ), making it challenging to draw conclusions about HFNC effectiveness, safety [ 22 , 23 ) or appropriateness [ 24 ]. Therefore, the purpose of this systematic review was to synthesize evidence pertaining to the effectiveness of HFNC in adults hospitalized for treatment of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: A systematic review

Arruda¹,

Kieling²,

Melo-Diaz³

2023

Can J Respir Ther

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Introduction/Background Coronavirus disease 2019 (COVID-19) has high transmissibility and mortality rates. High-flow nasal cannula therapy (HFNC) might reduce the need for orotracheal intubation, easing the burden on the health system caused by COVID-19. The objective of the present study was to examine the effectiveness of HFNC in adult patients hospitalized with COVID-19. Specifically, the present study explores the effects of HFNC on rates of mortality, intubation and intensive care units (ICU) length of stay. The present study also seeks to define predictors of success and failure of HFNC. Methods A systematic literature search was conducted in the PubMed, EMBASE and SCOPUS databases, and the study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using the National Heart, Lung, and Blood Institute’s Study Quality Assessment Tools. Results The search identified 1,476 unique titles; 95 articles received full-text reviews and 40 studies were included in this review. HFNC was associated with a reduction in the rate of orotracheal intubation, notably when compared to conventional oxygen therapy. Studies reported inconsistency in whether HFNC reduced ICU length of stay or mortality rates. Among the predictors of HFNC failure/success, a ratio of oxygen saturation index of approximately 5 or more was associated with HFNC success. Conclusion In adult patients hospitalized with COVID-19, HFNC may prove effective in reducing the rate of orotracheal intubation. The ratio of the oxygen saturation index was the parameter most examined as a predictor of HFNC success. Low-level research designs, inherent study weaknesses and inconsistent findings made it impossible to conclude whether HFNC reduces ICU length of stay or mortality. Future studies should employ higher level research designs.

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“…[ 17 ] A previous study revealed that diabetic patients with COVID-19 could benefit from using HFNC based on their statistical analysis results. [ 18 ] Another study examined obesity and other risk factors related to HFNC. It was associated with a reduction in functional residual capacity (FRC) and major breathing issues, including increased work of breath and ventilation-perfusion mismatch.…”

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The efficiency of high-flow nasal cannula for adult patients with coronavirus disease 19 in Jeddah, Saudi Arabia

et al. 2022

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CONTEXT: Early use of a high-flow nasal cannula (HFNC) provides positive outcomes for preventing the risk of intubation. However, the efficiency and usage of HFNC in the case of coronavirus disease 2019 (COVID-19) among adult patients with multiple risk factors remain debatable and require more investigation. AIMS: The aim of this study was to determine the efficiency of HFNC in preventing the possible risk of intubation. SETTINGS AND DESIGN: This study was an observational cross-sectional study that was conducted at a selected hospital in Jeddah, Saudi Arabia, from July 2020 to August 2021. METHODS: The data were collected from patients’ medical records through the hospital health information system. Adult COVID-19 patients who used HFNC were included, while those who used bilevel positive airway pressure or continuous positive airway pressure without any trials of HFNC and neonatal or pediatric patients were excluded. The exposure of HFNC setting which included variables such as percentages of the fraction of inspired oxygen and the duration of using HFNC were measured to find the relation with respiratory rate oxygenation (ROX) index as a measurement of patient outcome. STATISTICAL ANALYSIS USED: The data were analyzed by using the online calculator socscistatistics. com for prevalence statistics, and correlation tests of significance. Prevalence statistics were presented in mean, median, frequencies, and percentages. Statistical tests were used to measure correlations of key variables. P < 0.05 of ANOVA and t -tests was considered statistically significant. RESULTS: A total of 159 adult COVID-19 patients using HFNC were included, and most of these patients were male. The median age was 64 years. Most of patients were reported to have hypertension and diabetes mellitus. The majority (94.34%) of patients were successfully weaned from HFNC and shows effective intervention with a mean of 7.53 of ROX score. Appropriate implementation of HFNC might be a successful intervention for preventing the risk of intubation. CONCLUSIONS: According to the success rate of HFNC, which was considered a positive outcome, there might be a promising intervention for HFNC to prevent the risk of intubation and decrease the mortality rate.

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Stratifying risk outcomes among adult COVID-19 inpatients with high flow oxygen: The R4 score

Cited by 5 publications

References 29 publications

Prognostic models in COVID-19 infection that predict severity: a systematic review

Prognostic models in COVID-19 infection that predict severity: a systematic review

Effectiveness of high-flow nasal cannula therapy on clinical outcomes in adults with COVID-19: A systematic review

The efficiency of high-flow nasal cannula for adult patients with coronavirus disease 19 in Jeddah, Saudi Arabia

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