The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019

Küçük, Murat; Ergan, Begüm; Yakar, Mehmet Nuri; Ergün, Bişar; Akdoğan, Yunus; Cantürk, Ali; Gezer, Naciye Sinem; Kalkan, Fahreddin; Yaka, Erdem; Cömert, Bilgin; Gökmen, Necati

doi:10.4274/balkanmedj.galenos.2021.2021-7-32

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…Their identification and the volumetric quantification may allow an easier classification in terms of gravity, extent and progression of the disease. Moreover, this may provide a high-impact tool to enhance awareness of the severity of COVID-19 pneumonia [ 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ].…”

Section: Introductionmentioning

confidence: 99%

Imaging Severity COVID-19 Assessment in Vaccinated and Unvaccinated Patients: Comparison of the Different Variants in a High Volume Italian Reference Center

Granata

Fusco

Villanacci

et al. 2022

JPM

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Purpose: To analyze the vaccine effect by comparing five groups: unvaccinated patients with Alpha variant, unvaccinated patients with Delta variant, vaccinated patients with Delta variant, unvaccinated patients with Omicron variant, and vaccinated patients with Omicron variant, assessing the “gravity” of COVID-19 pulmonary involvement, based on CT findings in critically ill patients admitted to Intensive Care Unit (ICU). Methods: Patients were selected by ICU database considering the period from December 2021 to 23 March 2022, according to the following inclusion criteria: patients with proven Omicron variant COVID-19 infection with known COVID-19 vaccination with at least two doses and with chest Computed Tomography (CT) study during ICU hospitalization. Wee also evaluated the ICU database considering the period from March 2020 to December 2021, to select unvaccinated consecutive patients with Alpha variant, subjected to CT study, consecutive unvaccinated and vaccinated patients with Delta variant, subjected to CT study, and, consecutive unvaccinated patients with Omicron variant, subjected to CT study. CT images were evaluated qualitatively using a severity score scale of 5 levels (none involvement, mild: ≤25% of involvement, moderate: 26–50% of involvement, severe: 51–75% of involvement, and critical involvement: 76–100%) and quantitatively, using the Philips IntelliSpace Portal clinical application CT COPD computer tool. For each patient the lung volumetry was performed identifying the percentage value of aerated residual lung volume. Non-parametric tests for continuous and categorical variables were performed to assess statistically significant differences among groups. Results: The patient study group was composed of 13 vaccinated patients affected by the Omicron variant (Omicron V). As control groups we identified: 20 unvaccinated patients with Alpha variant (Alpha NV); 20 unvaccinated patients with Delta variant (Delta NV); 18 vaccinated patients with Delta variant (Delta V); and 20 unvaccinated patients affected by the Omicron variant (Omicron NV). No differences between the groups under examination were found (p value > 0.05 at Chi square test) in terms of risk factors (age, cardiovascular diseases, diabetes, immunosuppression, chronic kidney, cardiac, pulmonary, neurologic, and liver disease, etc.). A different median value of aerated residual lung volume was observed in the Delta variant groups: median value of aerated residual lung volume was 46.70% in unvaccinated patients compared to 67.10% in vaccinated patients. In addition, in patients with Delta variant every other extracted volume by automatic tool showed a statistically significant difference between vaccinated and unvaccinated group. Statistically significant differences were observed for each extracted volume by automatic tool between unvaccinated patients affected by Alpha variant and vaccinated patients affected by Delta variant of COVID-19. Good statistically significant correlations among volumes extracted by automatic tool for each lung lobe and overall radiological severity score were obtained (ICC range 0.71–0.86). GGO was the main sign of COVID-19 lesions on CT images found in 87 of the 91 (95.6%) patients. No statistically significant differences were observed in CT findings (ground glass opacities (GGO), consolidation or crazy paving sign) among patient groups. Conclusion: In our study, we showed that in critically ill patients no difference were observed in terms of severity of disease or exitus, between unvaccinated and vaccinated patients. The only statistically significant differences were observed, with regard to the severity of COVID-19 pulmonary parenchymal involvement, between unvaccinated patients affected by Alpha variant and vaccinated patients affected by Delta variant, and between unvaccinated patients with Delta variant and vaccinated patients with Delta variant.

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Section: Introductionmentioning

confidence: 99%

Imaging Severity COVID-19 Assessment in Vaccinated and Unvaccinated Patients: Comparison of the Different Variants in a High Volume Italian Reference Center

Granata

Fusco

Villanacci

et al. 2022

JPM

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“…Recently, attempts to evaluate the severity of lung injury by scoring CT images of AHRF due to COVID-19 have also been reported. As one example, the total severity score (TSS) score is a scoring system in which the ratio of the volume of infiltrative shadows in the lung is scored on a 5-point scale for each of the five lobes of the lung, and a total score ranging from 0 to 20 is calculated ( Kucuk et al, 2022 ; Li et al, 2020 ; Tharwat et al, 2022 ). High TTS scores indicate more severe disease.…”

Section: Discussionmentioning

confidence: 99%

Choice of respiratory therapy for COVID-19 patients with acute hypoxemic respiratory failure: a retrospective case series study

Sudo

Sawa

Kushimoto

et al. 2023

PeerJ

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Background In the treatment of acute hypoxemic respiratory failure (AHRF) due to coronavirus 2019 (COVID-19), physicians choose respiratory management ranging from low-flow oxygen therapy to more invasive methods, depending on the severity of the patient’s symptoms. Recently, the ratio of oxygen saturation (ROX) index has been proposed as a clinical indicator to support the decision for either high-flow nasal cannulation (HFNC) or mechanical ventilation (MV). However, the reported cut-off value of the ROX index ranges widely from 2.7 to 5.9. The objective of this study was to identify indices to achieve empirical physician decisions for MV initiation, providing insights to shorten the delay from HFNC to MV. We retrospectively analyzed the ROX index 6 hours after initiating HFNC and lung infiltration volume (LIV) calculated from chest computed tomography (CT) images in COVID-19 patients with AHRF. Methods We retrospectively analyzed the data for 59 COVID-19 patients with AHRF in our facility to determine the cut-off value of the ROX index for respiratory therapeutic decisions and the significance of radiological evaluation of pneumonia severity. The physicians chose either HFNC or MV, and the outcomes were retrospectively analyzed using the ROX index for initiating HFNC. LIV was calculated using chest CT images at admission. Results Among the 59 patients who required high-flow oxygen therapy with HFNC at admission, 24 were later transitioned to MV; the remaining 35 patients recovered. Four of the 24 patients in the MV group died, and the ROX index values of these patients were 9.8, 7.3, 5.4, and 3.0, respectively. These index values indicated that the ROX index of half of the patients who died was higher than the reported cut-off values of the ROX index, which range from 2.7–5.99. The cut-off value of the ROX index 6 hours after the start of HFNC, which was used to classify the management of HFNC or MV as a physician’s clinical decision, was approximately 6.1. The LIV cut-off value on chest CT between HFNC and MV was 35.5%. Using both the ROX index and LIV, the cut-off classifying HFNC or MV was obtained using the equation, LIV = 4.26 × (ROX index) + 7.89. The area under the receiver operating characteristic curve, as an evaluation metric of the classification, improved to 0.94 with a sensitivity of 0.79 and specificity of 0.91 using both the ROX index and LIV. Conclusion Physicians’ empirical decisions associated with the choice of respiratory therapy for HFNC oxygen therapy or MV can be supported by the combination of the ROX index and the LIV index calculated from chest CT images.

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“…If P/F less than 150mmHg it's unclear what respiratory support it's better, but the patient should be closely monitored. (12) ROX Index is the most used failure predictor of this therapy in all causes of acute respiratory failure (13) also due to COVID-19 (14)(15)(16) An analytical value in blood could be more stable than the ROX index since it will not depend on the vital signs that the patient presents at that moment. COVID-19 Spanish ICU Network published in 2021 a multicenter, observational study from a prospectively collected database of consecutive COVID-19 patients who received HFT on ICU admission.…”

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confidence: 99%

Biomarkers of High Flow Therapy Outcome in COVID-19 pneumonia: a single-center prospective study

Marín,

Aldás,

Galdeano

et al. 2024

Preprint

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Patients with acute hypoxemic respiratory failure (AHRF) due to COVID-19 undergoing High Flow Therapy (HFT) before intubation presented an increased risk of mortality when intubation was delayed. We designed a prospective study seeking biomarkers for early prediction of HFT failure. An analytical value in blood could be more stable than the ROX index since it will not depend on the vital signs that the patient presents at that moment. We defined HFT failure as the need to scale the treatment to Non-Invasive Positive Pressure Ventilation (NPPV). The needs were respiratory rate >25, oxygen saturation of <90% despite being on flow of 60 l·min-1 and FiO2 1 or levels of PaO2/FiO2 ratio <100mmHg. The all-treatment population included all subjects enrolled in the trial. 139 patients were enrolled after starting HFT. The Pearson chi-squared test was used to compare the main study outcomes. These included the incidence of intubation, the cumulative incidence of mortality at 30 days, the cumulative incidence of mortality at 1 year, and the composite outcome of intubation or death at the end of the trial. Kaplan-Meyer plot was used to illustrate the time to HFT failure. The Cox regression model was used to estimate the hazard ratio for HFT failure for all the parameters. All were measured or collected at baseline. Lower levels of bicarbonate, thrombocytopenia, and higher levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), creatinine, and glucose are early blood biomarkers independently associated with HFT failure.SUMMARY AT A GLANCEHigher levels of C-reactive protein and lactate dehydrogenase in patients with COVID-19 pneumonia allow us to early detect patients requiring intubation with an apparent good response to high-flow oxygen therapy.

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The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019

Cited by 6 publications

References 24 publications

Imaging Severity COVID-19 Assessment in Vaccinated and Unvaccinated Patients: Comparison of the Different Variants in a High Volume Italian Reference Center

Imaging Severity COVID-19 Assessment in Vaccinated and Unvaccinated Patients: Comparison of the Different Variants in a High Volume Italian Reference Center

Choice of respiratory therapy for COVID-19 patients with acute hypoxemic respiratory failure: a retrospective case series study

Biomarkers of High Flow Therapy Outcome in COVID-19 pneumonia: a single-center prospective study

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