Pettenuzzo Tommaso, Giraudo Chiara, Fichera Giulia, Della Paolera Michele, Tocco Martina, Weber Michael, Gorgi Davide, Carlucci Silvia, Lionello Federico, Lococo Sara, Boscolo Annalisa, De Cassai Alessandro, Pasin Laura, Rossato Marco, Vianello Andrea, Vettor Roberto, Sella Nicolò, Navalesi Paolo
Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy.
Institute of Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy.
J Clin Med. 2022 Mar 16;11(6):1636. doi: 10.3390/jcm11061636.
Forms of noninvasive respiratory support (NIRS) have been widely used to avoid endotracheal intubation in patients with coronavirus disease-19 (COVID-19). However, inappropriate prolongation of NIRS may delay endotracheal intubation and worsen patient outcomes. The aim of this retrospective study was to assess whether the CARE score, a chest X-ray score previously validated in COVID-19 patients, may predict the need for endotracheal intubation and escalation of respiratory support in COVID-19 patients requiring NIRS. From December 2020 to May 2021, we included 142 patients receiving NIRS who had a first chest X-ray available at NIRS initiation and a second one after 48-72 h. In 94 (66%) patients, the level of respiratory support was increased, while endotracheal intubation was required in 83 (58%) patients. The CARE score at NIRS initiation was not predictive of the need for endotracheal intubation (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.96-1.06) or escalation of treatment (OR 1.01, 95% CI 0.96-1.07). In conclusion, chest X-ray severity, as assessed by the CARE score, did not allow predicting endotracheal intubation or escalation of respiratory support in COVID-19 patients undergoing NIRS.
无创呼吸支持（NIRS）形式已被广泛用于避免冠状病毒病19（COVID-19）患者进行气管插管。然而，不适当延长NIRS可能会延迟气管插管并使患者预后恶化。这项回顾性研究的目的是评估CARE评分（先前在COVID-19患者中验证过的胸部X线评分）是否可预测需要NIRS的COVID-19患者进行气管插管和呼吸支持升级的必要性。从2020年12月至2021年5月，我们纳入了142例接受NIRS的患者，这些患者在开始NIRS时有第一张可用胸部X线片，在48 - 72小时后有第二张。在94例（66%）患者中，呼吸支持水平提高，而83例（58%）患者需要气管插管。开始NIRS时的CARE评分不能预测气管插管的必要性（比值比（OR）1.01，95%置信区间（CI）0.96 - 1.06）或治疗升级（OR 1.01，95% CI 0.96 - 1.07）。总之，通过CARE评分评估的胸部X线严重程度不能预测接受NIRS的COVID-19患者的气管插管或呼吸支持升级情况。
