دورية أكاديمية
An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy
| العنوان: | An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy |
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| المؤلفون: | Roca, Oriol, Caralt, Berta, Messika, Jonathan, Samper, Manuel, Sztrymf, Benjamin, Hernández, Gonzalo, García-De-Acilu, Marina, Frat, Jean-Pierre, Masclans, Joan, Ricard, Jean-Damien |
| المساهمون: | Vall d’Hebron Research Institute (VHIR), Instituto de Salud Carlos III Madrid (ISC), Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona (UAB), Service de Réanimation Médico-Chirurgicale Hôpital Louis Mourier, Hôpital Louis Mourier - AP-HP Colombes, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, IMIM-Hospital del Mar, Generalitat de Catalunya = Generalidad de Cataluña = Government of Catalonia, Hypertension arterielle pulmonaire physiopathologie et innovation thérapeutique (HPPIT), Centre Chirurgical Marie Lannelongue (CCML)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Antoine Béclère Clamart, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Genetics and Microbiology, Hospital Virgen de la Salud, CIC Poitiers – Centre d'investigation clinique de Poitiers (CIC 1402), Université de Poitiers = University of Poitiers (UP)-Centre hospitalier universitaire de Poitiers = Poitiers University Hospital (CHU de Poitiers La Milétrie )-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Université de Poitiers = University of Poitiers (UP) |
| المصدر: | ISSN: 1073-449X. |
| بيانات النشر: | HAL CCSD American Thoracic Society |
| سنة النشر: | 2019 |
| المجموعة: | Université Paris 13: HAL |
| مصطلحات موضوعية: | high-flow nasal cannula, nasal high flow, acute respiratory failure, pneumonia, MESH: Aged, MESH: Blood Gas Analysis, MESH: Middle Aged, MESH: Noninvasive Ventilation / standards, MESH: Oxygen Inhalation Therapy / standards, MESH: Pneumonia / therapy, MESH: Practice Guidelines as Topic, MESH: Prospective Studies, MESH: Respiratory Rate, MESH: Catheterization / standards, MESH: Cohort Studies, MESH: Data Accuracy, MESH: Diagnostic Techniques and Procedures / standards, MESH: Extracorporeal Membrane Oxygenation / standards, MESH: Female, MESH: Humans, MESH: Male, [SDV]Life Sciences [q-bio] |
| الوصف: | International audience ; Rationale: One important concern during high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemic respiratory failure is to not delay intubation. Objectives: To validate the diagnostic accuracy of an index (termed ROX and defined as the ratio of oxygen saturation as measured by pulse oximetry/FiO2 to respiratory rate) for determining HFNC outcome (need or not for intubation). Methods: This was a 2-year multicenter prospective observational cohort study including patients with pneumonia treated with HFNC. Identification was through Cox proportional hazards modeling of ROX association with HFNC outcome. The most specific cutoff of the ROX index to predict HFNC failure and success was assessed. Measurements and Main Results: Among the 191 patients treated with HFNC in the validation cohort, 68 (35.6%) required intubation. The prediction accuracy of the ROX index increased over time (area under the receiver operating characteristic curve: 2 h, 0.679; 6 h, 0.703; 12 h, 0.759). ROX greater than or equal to 4.88 measured at 2 (hazard ratio, 0.434; 95% confidence interval, 0.264-0.715; P = 0.001), 6 (hazard ratio, 0.304; 95% confidence interval, 0.182-0.509; P < 0.001), or 12 hours (hazard ratio, 0.291; 95% confidence interval, 0.161-0.524; P < 0.001) after HFNC initiation was consistently associated with a lower risk for intubation. A ROX less than 2.85, less than 3.47, and less than 3.85 at 2, 6, and 12 hours of HFNC initiation, respectively, were predictors of HFNC failure. Patients who failed presented a lower increase in the values of the ROX index over the 12 hours. Among components of the index, oxygen saturation as measured by pulse oximetry/FiO2 had a greater weight than respiratory rate. Conclusions: In patients with pneumonia with acute respiratory failure treated with HFNC, ROX is an index that can help identify those patients with low and those with high risk for intubation. Clinical trial registered with www.clinicaltrials.gov (NCT02845128). |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | hal-04526630; https://hal.science/hal-04526630Test |
| DOI: | 10.1164/rccm.201803-0589OC |
| الإتاحة: | https://doi.org/10.1164/rccm.201803-0589OCTest https://hal.science/hal-04526630Test |
| رقم الانضمام: | edsbas.84E6DE1 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1164/rccm.201803-0589OC |
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