Choice of respiratory therapy for COVID-19 patients with acute hypoxemic respiratory failure: a retrospective case series study.
Choice of respiratory therapy for COVID-19 patients with acute hypoxemic respiratory failure: a retrospective case series study.
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作者：
Sudo K;Sawa T;Kushimoto K;Yoshii R;Yuasa K;Inoue K;Kinoshita M;Yamasaki M;Kooguchi K
在治疗2019冠状病毒（COVID-19）引起的急性低氧性呼吸衰竭（AHRF）时，医生根据患者症状的严重程度，选择从低流量氧疗到更具侵入性的呼吸管理方法。近年来，氧饱和度比值（ROX）指数被提出作为临床上支持高流量鼻插管（HFNC）或机械通气（MV）决策的指标。然而，报告的ROX指数的临界值在2.7至5.9之间相差很大。本研究的目的是确定指标，以获得经验医师对MV启动的决策，为缩短HFNC到MV的延迟提供见解。我们回顾性分析了HFNC启动后6小时的ROX指数和由胸部计算机断层扫描（CT）图像计算的COVID-19合并AHRF患者的肺浸润体积（LIV）。我们回顾性分析了本院59例COVID-19 AHRF患者的数据，以确定ROX指数在呼吸治疗决策中的临界值和肺炎严重程度影像学评估的意义。医生选择HFNC或MV，并使用启动HFNC的ROX指数对结果进行回顾性分析。使用入院时胸部CT图像计算LIV。入院时需要HFNC高流量氧疗的59例患者中，24例后来过渡到MV；其余35例患者痊愈。MV组24例患者中4例死亡，ROX指数分别为9.8、7.3、5.4、3.0。这些指标值表明，半数死亡患者的ROX指数高于报道的ROX指数临界值（2.7-5.99）。HFNC开始后6小时ROX指数的临界值约为6.1，用于将HFNC或MV的管理分类为医生的临床决策。HFNC与MV在胸部CT上的LIV临界值为35.5%。同时使用ROX指数和LIV，用LIV = 4.26 × （ROX指数）+ 7.89得到HFNC或MV分类的截止值。使用ROX指数和LIV，受试者工作特征曲线下面积作为分类的评价指标提高到0.94，灵敏度为0.79，特异性为0.91。通过结合胸部CT图像计算的ROX指数和LIV指数，可以支持医生在选择HFNC氧疗或MV呼吸治疗时的经验决策。
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. 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. 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. 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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影响因子：
2.3
作者：
Panadero C;Abad-Fernández A;Rio-Ramirez MT;Acosta Gutierrez CM;Calderon-Alcala M;Lopez-Riolobos C;Matesanz-Lopez C;Garcia-Prieto F;Diaz-Garcia JM;Raboso-Moreno B;Vasquez-Gambasica Z;Andres-Ruzafa P;Garcia-Satue JL;Calero-Pardo S;Sagastizabal B;Bautista D;Campos A;González M;Grande L;Jimenez Fernandez M;Santiago-Ruiz JL;Caravaca Perez P;Alcaraz AJ
通讯作者：
Alcaraz AJ
影响因子：
3.7
作者：
Prakash J;Bhattacharya PK;Yadav AK;Kumar A;Tudu LC;Prasad K
通讯作者：
Prasad K
DOI：
10.1111/crj.13515
发表时间：
2022-07
期刊：
The clinical respiratory journal
影响因子：
--
作者：
通讯作者：
--
影响因子：
4.3
作者：
Ferrer S;Sancho J;Bocigas I;Bures E;Mora H;Monclou E;Mulet A;Quezada A;Royo P;Signes-Costa J
通讯作者：
Signes-Costa J
影响因子：
38.9
作者：
Kang, Byung Ju;Koh, Younsuck;Hong, Sang-Bum
通讯作者：
Hong, Sang-Bum