High-Flow Nasal Cannula Therapy in COVID-19: Using the ROX Index to Predict Success
High-Flow Nasal Cannula Therapy in COVID-19: Using the ROX Index to Predict Success
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DOI：
10.4187/respcare.08631
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发表时间：
2021-06-01
期刊：
影响因子：
2.5
通讯作者：
King, Christopher S.
中科院分区：
文献类型：
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作者：
Chandel, Abhimanyu;Patolia, Saloni;King, Christopher S.
背景：COVID-19下机械通气的最佳时机尚不确定。我们试图评估延迟插管的结局，并检查ROX指数（即[S-pO 2/F-IO 2]/呼吸频率），以预测COVID-19患者从高流量鼻插管（HFNC）中脱机。方法：我们对因COVID-19导致呼吸衰竭并接受HFNC治疗的受试者进行了一项多中心、回顾性、观察性队列研究。应用ROX指数预测HFNC成功。HFNC失败的受试者分为早期HFNC失败（48 h）。标准统计比较和回归分析用于比较早期和晚期衰竭组的总体住院死亡率和次要终点，包括时间特异性死亡率、体外膜肺氧合需求和ICU住院时间。结果：272名COVID-19受试者接受了HFNC治疗。164例（60.3%）成功脱离HFNC，其中111例（67.7%）仅在非ICU环境中进行管理。在HFNC开始后2、6和12小时ROX指数>3.0对于识别随后HFNC成功的敏感性为85.3%。108例受试者因HFNC失败而插管（61例早期失败和47例晚期失败）。HFNC失败后死亡率高（45.4%）。早期和晚期HFNC失败组的住院死亡率（39.3% vs 53.2%，P = 0.18）或任何次要终点无统计学差异。即使对协变量进行调整，这仍然是正确的。结论：在这项回顾性审查中，HFNC是一种可行的策略，大多数受试者不需要机械通气。在少数进展为机械通气的受试者中，HFNC的持续时间并不能区分临床结局较差的受试者。ROX指数对于识别成功脱离HFNC的受试者是敏感的。有必要对COVID-19进行前瞻性研究，以证实这些发现，并优化HFNC在这种疾病中使用的患者选择。
BACKGROUND: Optimal timing of mechanical ventilation in COVID-19 is uncertain. We sought to evaluate outcomes of delayed intubation and examine the ROX index (ie, [S-pO2/F-IO2]/breathing frequency) to predict weaning from high-flow nasal cannula (HFNC) in patients with COVID-19. METHODS: We performed a multicenter, retrospective, observational cohort study of subjects with respiratory failure due to COVID-19 and managed with HFNC. The ROX index was applied to predict HFNC success. Subjects that failed HFNC were divided into early HFNC failure ( 48 h). Standard statistical comparisons and regression analyses were used to compare overall hospital mortality and secondary end points, including time-specific mortality, need for extracorporeal membrane oxygenation, and ICU length of stay between early and late failure groups. RESULTS: 272 subjects with COVID-19 were managed with HFNC. One hundred sixty-four (60.3%) were successfully weaned from HFNC, and 111 (67.7%) of those weaned were managed solely in non-ICU settings. ROX index >3.0 at 2, 6, and 12 hours after initiation of HFNC was 85.3% sensitive for identifying subsequent HFNC success. One hundred eight subjects were intubated for failure of HFNC (61 early failures and 47 late failures). Mortality after HFNC failure was high (45.4%). There was no statistical difference in hospital mortality (39.3% vs 53.2%, P = .18) or any of the secondary end points between early and late HFNC failure groups. This remained true even when adjusted for covariates. CONCLUSIONS: In this retrospective review, HFNC was a viable strategy and mechanical ventilation was unecessary in the majority of subjects. In the minority that progressed to mechanical ventilation, duration of HFNC did not differentiate subjects with worse clinical outcomes. The ROX index was sensitive for the identification of subjects successfully weaned from HFNC. Prospective studies in COVID-19 are warranted to confirm these findings and to optimize patient selection for use of HFNC in this disease.Y