COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU.
COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU.
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DOI：
10.1016/j.pulmoe.2021.04.003
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发表时间：
2022-01
期刊：
影响因子：
11.7
通讯作者：
Nava S
中科院分区：
文献类型：
--
作者：
Vega ML;Dongilli R;Olaizola G;Colaianni N;Sayat MC;Pisani L;Romagnoli M;Spoladore G;Prediletto I;Montiel G;Nava S
高流量鼻插管(HFNC)用于治疗急性低氧性呼吸衰竭(AHRF)，即使在ICU外，ROX指数(脉搏血氧饱和度/吸入氧/呼吸频率)可以预测HFNC失败。因此，这项研究的目的是验证ROX指数是否可以准确预测重症监护病房(ICU)外接受新冠肺炎治疗的患者高频NC失败的可能性，并评估先前提出的阈值的有效性。多中心研究。对前瞻性收集的数据进行回溯性观察分析。3个专门从事非侵入性呼吸支持的中心(阿根廷布宜诺斯艾利斯；意大利博尔扎诺和特雷维索)。对ICU外治疗的患者进行分析，在治疗第1天的2、6、12和24小时收集计算ROX指数的变量，然后每24小时记录一次。HFNC失败定义为呼吸支持升级为有创机械通气(IMV)或死亡。共有35名患者(29%)未通过HFNC，需要插管。ROC分析确定12小时ROX指数是预测插管的最佳指标，其AUC值为0.7916[可信区间95%0.6905~0.8927]，最佳阈值为5.99[特异度96%，敏感度62%]。在生存分析中，ROX值为5.99与失败风险增加相关(p = 0008 对数列检验)。ROCA认为阈值4，9是非冠状病毒感染患者的最佳预测因子，在我们的患者中不能区分成功和失败(p = 0.4 对数等级检验)。ROX指数可能有助于指导临床医生决定为患者插管，特别是对中度ARF患者，因此在ICU外进行治疗。事实上，它还显示了与非COVID患者报告的不同的阈值，可能与不同的缺氧机制有关。
High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure. The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold. Multicenter study. Retrospective observational analysis of prospectively collected data. 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death. A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI 95% 0.6905-0.8927] and the best threshold to be 5.99[Specificity 96% Sensitivity 62%]. In the survival analysis, a ROX value <5.99 was associated with an increased risk of failure (p = 0008 log – rank test). The threshold of 4,9 identified by Roca as the best predictor in non-COVID patients, was not able to discriminate between success and failure (p = 0.4 log-rank test) in our patients. ROX index may be useful in guiding the clinicians in their decision to intubate patients, especially in patients with moderate ARF, treated therefore outside the ICU. Indeed, it also demonstrates a different threshold value than reported for non-COVID patients, possibly related to the different mechanisms of hypoxia.
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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：
24.3
作者：
Franco, Cosimo;Facciolongo, Nicola;Nava, Stefano
通讯作者：
Nava, Stefano
影响因子：
38.9
作者：
Kang, Byung Ju;Koh, Younsuck;Hong, Sang-Bum
通讯作者：
Hong, Sang-Bum
DOI：
10.1016/s2213-2600(20)30370-2
发表时间：
2020-12
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Grasselli G;Tonetti T;Protti A;Langer T;Girardis M;Bellani G;Laffey J;Carrafiello G;Carsana L;Rizzuto C;Zanella A;Scaravilli V;Pizzilli G;Grieco DL;Di Meglio L;de Pascale G;Lanza E;Monteduro F;Zompatori M;Filippini C;Locatelli F;Cecconi M;Fumagalli R;Nava S;Vincent JL;Antonelli M;Slutsky AS;Pesenti A;Ranieri VM;collaborators
通讯作者：
collaborators
影响因子：
10
作者：
Warren MA;Zhao Z;Koyama T;Bastarache JA;Shaver CM;Semler MW;Rice TW;Matthay MA;Calfee CS;Ware LB
通讯作者：
Ware LB