Murat KÜÇÜK, Begüm ERGAN, Mehmet Nuri YAKAR, Bişar ERGÜN, Yunus AKDOĞAN, Ali CANTÜRK, Naciye Sinem GEZER, Fahreddin KALKAN, Erdem YAKA, Bilgin CÖMERT, Necati Ali GÖKMEN

The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019

Background: The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality. Aims: To define the related risk factors to HFNO failure and hospital mortality Study Design: Retrospective cohort study. Methods: To this study, 85 critically ill patients (≥18 years) with COVID-19 related acute kidney injury who were treated with HFNO were enrolled. Treatment success was defined as the de-escalation of the oxygenation support to the conventional oxygen therapies. HFNO therapy failure was determined as the need for invasive mechanical ventilation or death. The patients were divided into HFNO-failure (HFNO-F) and HFNO-success (HFNO-S) groups. Electronic medical records and laboratory data were screened for all patients. Respiratory rate oxygenation (ROX) index on the first hour and chest computed tomography (CT) severity score were calculated. Factors related to HFNO therapy failure and mortality were defined. Results: This study assessed 85 patients (median age 67 years, 69.4% male) who were divided into two groups as HFNO success (n = 33) and HFNO failure (n = 52). The respiratory rate oxygenation (ROX) was measured at 1 hour and the computed tomography (CT) score indicated HFNO failure and intubation, with an area under the receiver operating characteristic of 0.695 for the ROX index and 0.628 for the CT score. A ROX index of 15 in the first hour of therapy were the predictors of HFNO failure and intubation. Age, Acute Physiology and Chronic Health Evaluation II score, arterial blood gas findings “(i.e., partial pressure of oxygen [PaO2], PaO2 [fraction of inspired oxygen]/SO2 [oxygen saturation] ratio)”, and D-dimer levels were also associated with HFNO failure; however, based on logistic regression analysis, a calculated ROX on the first hour of therapy of 15 (OR = 2.83, 95% CI = 1.01–7.88, P =

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1. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382:727-733. [Crossref]
2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. [Crossref]
3. Cinesi Gómez C, Peñuelas Rodríguez Ó, Luján Torné ML, et al. Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection. Med Intensiva (Engl Ed). 2020;67:261-270. [Crossref]
4. Rochwerg B, Granton D, Wang DX, et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019;45:563-572. [Crossref]
5. Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med. 2020;46:1099- 1102. [Crossref]
6. de Simone G, Mancusi C. COVID-19: Timing is Important. Eur J Intern Med. 2020;77:134-135. [Crossref]
7. Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care. 2020;10:78. [Crossref]
8. Rola P, Farkas J, Spiegel R, et al. Rethinking the early intubation paradigm of COVID-19: Time to change gears?. Clin Exp Emerg Med. 2020;7:78-80. [Crossref]
9. Roca O, Caralt B, Messika J, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med. 2019;199:1368-1376. [Crossref]
10. Calligaro GL, Lalla U, Audley G, et al. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study. EClinicalMedicine. 2020;28:100570. [Crossref]
11. Ferrando C, Mellado-Artigas R, Gea A, et al. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: A multicenter, adjusted cohort study. Crit Care. 2020;24:597. [Crossref]
12. Hu M, Zhou Q, Zheng R, et al. Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. BMC Pulm Med. 2020;20:324. [Crossref]
13. Patel M, Chowdhury J, Mills N, et al. ROX index predicts intubation in patients with COVID-19 pneumonia and moderate to severe hypoxemic respiratory failure receiving high flow nasal therapy. medRxiv. 2020. medRxiv preprint doi: https://doi. org/10.1101/2020.06.30.20143867. [CrossRef]
14. Mellado-Artigas R, Mujica LE, Ruiz ML, et al. Predictors of failure with highflow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study. J Intensive Care. 2021;9:23. [CrossRef]
15. Saeed GA, Gaba W, Shah A, et al. Correlation between Chest CT severity scores and the clinical parameters of adult patients with COVID-19 pneumonia. Radiol Res Pract. 2021;2021:6697677. [CrossRef]
16. Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30:6808- 6817. [CrossRef]
17. Chang YC, Yu CJ, Chang SC, et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: Evaluation with thin-section CT. Radiology. 2005;236:1067-1075. [CrossRef]
18. Panadero C, Abad-Fernández A, Rio-Ramirez MT, et al. High-flow nasal cannula for acute respiratory distress syndrome (ARDS) due to COVID-19. Multidiscip Respir Med. 2020;15:693. [CrossRef]
19. Frat JP, Ragot S, Thille AW. High-flow nasal cannula oxygen in respiratory failure. N Engl J Med. 2015;373:1374-1375. [CrossRef]
20. Messika J, Ben Ahmed K, Gaudry S, et al. Use of high-flow nasal cannula oxygen therapy in subjects with ARDS: A 1-year observational study. Respir Care. 2015;60:162-169. [CrossRef]
21. Bauer PR, Gajic O, Nanchal R, et al. Association between timing of intubation and outcome in critically ill patients: a secondary analysis of the ICON audit. J Crit Care. 2017;42:1-5. [CrossRef]
22. Kangelaris KN, Ware LB, Wang CY, et al. Timing of intubation and clinical outcomes in adults with acute respiratory distress syndrome. Crit Care Med. 2016;44:120-129. [CrossRef]
23. Chandel A, Patolia S, Brown AW, et al. High-flow nasal cannula therapy in COVID-19: using the ROX index to predict success. Respir Care. 2021;66:909-919. [CrossRef]
24. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing for Coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296:E32-E40. [CrossRef]
25. Colombi D, Bodini FC, Petrini M, et al. Well-aerated lung on admitting chest CT to predict adverse outcome in COVID-19 pneumonia. Radiology. 2020;296:E86-E96. [CrossRef]