Patel Maulin, Chowdhury Junad, Mills Nicole, Marron Robert, Gangemi Andrew, Dorey-Stein Zachariah, Yousef Ibraheem, Zheng Matthew, Tragesser Lauren, Giurintano Julie, Gupta Rohit, Rali Parth, D'Alonzo Gilbert, Zhao Huaqing, Patlakh Nicole, Marchetti Nathaniel, Criner Gerard, Gordon Matthew
Department of Thoracic Medicine and Surgery Temple University Hospital Philadelphia, PA United States.
JMIRx Med. 2021 Aug 27;2(3):e29062. doi: 10.2196/29062. eCollection 2021 Jul-Sep.
The use of high-flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concerns about increased health care worker transmission and delays in invasive mechanical ventilation (IMV). Herein, we analyzed the utility of the noninvasive ROX (ratio of oxygen saturation) index to predict the need for and timing of IMV.
This study aimed to assess whether the ROX index can be a useful score to predict intubation and IMV in patients receiving HFNT as treatment for COVID-19-related hypoxemic respiratory failure.
This is a retrospective cohort analysis of 129 consecutive patients with COVID-19 admitted to Temple University Hospital in Philadelphia, PA, from March 10, 2020, to May 17, 2020. This is a single-center study conducted in designated COVID-19 units (intensive care unit and other wards) at Temple University Hospital. Patients with moderate and severe hypoxemic respiratory failure treated with HFNT were included in the study. HFNT patients were divided into two groups: HFNT only and intubation (ie, patients who progressed from HFNT to IMV). The primary outcome was the value of the ROX index in predicting the need for IMV. Secondary outcomes were mortality, rate of intubation, length of stay, and rate of nosocomial infections in a cohort treated initially with HFNT.
Of the 837 patients with COVID-19, 129 met the inclusion criteria. The mean age was 60.8 (SD 13.6) years, mean BMI was 32.6 (SD 8) kg/m², 58 (45%) were female, 72 (55.8%) were African American, 40 (31%) were Hispanic, and 48 (37.2%) were nonsmokers. The mean time to intubation was 2.5 (SD 3.3) days. An ROX index value of less than 5 at HFNT initiation was suggestive of progression to IMV (odds ratio [OR] 2.137, =.052). Any further decrease in ROX index value after HFNT initiation was predictive of intubation (OR 14.67, <.001). Mortality was 11.2% (n=10) in the HFNT-only group versus 47.5% (n=19) in the intubation group (<.001). Mortality and need for pulmonary vasodilators were higher in the intubation group.
The ROX index helps decide which patients need IMV and may limit eventual morbidity and mortality associated with the progression to IMV.
由于担心医护人员传播风险增加以及有创机械通气（IMV）延迟，高流量鼻导管治疗（HFNT）在治疗新型冠状病毒肺炎中的应用在全球范围内备受争议。在此，我们分析了无创ROX（氧饱和度比值）指数在预测IMV需求及时机方面的效用。
本研究旨在评估ROX指数能否作为预测接受HFNT治疗新型冠状病毒肺炎相关低氧性呼吸衰竭患者插管及IMV需求的有效评分指标。
这是一项对2020年3月10日至2020年5月17日期间连续入住宾夕法尼亚州费城坦普尔大学医院的129例新型冠状病毒肺炎患者进行的回顾性队列分析。这是在坦普尔大学医院指定的新型冠状病毒肺炎病房（重症监护病房及其他病房）开展的单中心研究。纳入接受HFNT治疗的中重度低氧性呼吸衰竭患者。HFNT患者分为两组：单纯HFNT组和插管组（即从HFNT进展至IMV的患者）。主要结局为ROX指数预测IMV需求的价值。次要结局为初始接受HFNT治疗队列中的死亡率、插管率、住院时长及医院感染率。
837例新型冠状病毒肺炎患者中，129例符合纳入标准。平均年龄为60.8（标准差13.6）岁，平均体重指数为32.6（标准差8）kg/m²，58例（45%）为女性，72例（55.8%）为非裔美国人，40例（31%）为西班牙裔，48例（37.2%）为非吸烟者。平均插管时间为2.5（标准差3.3）天。HFNT开始时ROX指数值小于5提示进展至IMV（比值比[OR]2.137，P =.052）。HFNT开始后ROX指数值的任何进一步下降均提示插管（OR 14.67，P<.001）。单纯HFNT组死亡率为11.2%（n = 10），插管组为47.5%（n = 19）（P<.001）。插管组死亡率及肺血管扩张剂需求更高。
ROX指数有助于确定哪些患者需要IMV，并可能限制与进展至IMV相关的最终发病率和死亡率。
