Salvador-Ibarra IJ, Pizaña DA

Language: Spanish
References: 27
Page: 250-255
PDF size: 269.02 Kb.

ABSTRACT

Acute hypoxemic respiratory failure (AHRF) is one of the main causes of admission to the intensive care unit in adult patients, around 40% of these patients require endotracheal intubation. The HACOR scale was designed and validated as a clinical prediction score for non-invasive ventilation (NIV) failure in patients with HAI of different etiologies. Objective: To analyze the predictive capacity of the HACOR scale in relation to the failure of the PNAF. Material and methods: A retrospective, observational study was carried out in the Intensive Care Unit at Hospital Ángeles Mocel, the PNAF was started when the patient had AHRF, the HACOR scale was calculated at one hour and 2 hours after the placement of the PNAF, the ability to predict HACOR scale PNAF failure was determined by calculating the area under the "receiver operating characteristic" (ROC) curve. Results: The HACOR scale with the highest discriminatory power was obtained 2 hours after the start of the PNAF with a cut-off point of 5 points with an area under the curve (AUC): 0.82 (CI 95% 0.67-0.98), it was obtained a sensitivity 84% CI 95% (56.6-89.9%), specificity 81% CI 95% (40.9-92.9%). Conclusions: A score greater than or equal to 5 points on the HACOR scale predicts failure of the PNAF and higher mortality with a sensitivity and specificity greater than 80% in patients with COVID-19 pneumonia.

REFERENCES

1. Spoletini G, Alotaibi M, Blasi F, Hill NS. Heated humidified high flow nasal oxygen in adults. Mechanism of action and clinical implications. Chest. 2015;148(1):253-261.

2. Nava S, Hill N. Non invasive ventilation in acute respiratory failure. Lancet. 2009;374(9685):250-259.

3. Guan WJ, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-1720.

4. Bazuaye EA, Stone TN, Corris PA, Gibson GJ. Variability of inspired oxygen concentration with nasal cannulas. Thorax. 1992;47(8):609-611.

5. Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with under humidified high-flow oxygen therapy in critically ill patients. Intensive Care Med. 2009;35(6):996-1003.

6. Mauri T, Wang YM, Corte FD, et al. Nasal high flow: physiology, efficacy and safety in the acute care setting, a narrative review. Open Access Emerg Med. 2019;11:109-120.

7. Helviz Y, Einav S. A systematic review of the high-flow nasal cannula for adult patients. Crit Care. 2018;22(1):71.

8. Roca O, Riera J, Torres F, Masclan JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55(4):408-413.

9. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369(22):2126-2136.

10. Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2):208.

11. Kang BJ, Koh Y, Lim CM, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015;41:623-632.

12. Duan J, Han X, Bai L, Zhou L, Huang S. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med. 2017;43(2):192-199.

13. Ricard JD, Roca O, Lemiale V, et al. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med. 2020;46:2238-2247.

14. Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011;37(11):1780-1786.

15. Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372(23):2185-2196.

16. Contreras A, Varela LE, Gaytán CJ, et al. Utilidad de escala HACOR para predecir falla de la ventilación mecánica no invasiva y mortalidad en las Unidades de Terapia Intensiva del Centro Médico ABC. An Med (Mex). 2018;63(4):261-265.

17. De Lusignan S, Dorward J, Correa A, et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study. Lancet Infect Dis. 2020;20(9):1034-1042.

18. Montopoli M, Zumerle S, Vettor R, et al. Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (n=4532). Ann Oncol. 2020;31(8):1040-1050.

19. Zeng F, Dai C, Cai P, et al. A comparison study of SARS-CoV-2 IgG antibody between male and female COVID-19 patients: a possible reason underlying different outcome between sex. J Med Virol. 2020;92(10):2050-2054.

20. Van Leeuwen HJ, Heezius EC, Dallinga GM, Van Strijp JA, Verhoef J, Van Kessel KP. Lipoprotein metabolism in patients with severe sepsis. Crit Care Med. 2003;31(5):1359-1366.

21. Barlage S, Gnewuch C, Liebisch G, et al. Changes in HDL-associated apolipoproteins relate to mortality in human sepsis and correlate to monocyte and platelet activation. Intensive Care Med. 2009;35(11):1877-1885.

22. Chien JY, Jerng JS, Yu CJ, Yang PC. Low serum level of high-density lipoprotein cholesterol is a poor prognostic factor for severe sepsis. Crit Care Med. 2005;33(8):1688-1693.

23. Cirstea M, Walley KR, Russell JA, Brunham LR, Genga KR, Boyd JH. Decreased high-density lipoprotein cholesterol level is an early prognostic marker for organ dysfunction and death in patients with suspected sepsis. J Crit Care. 2017;38:289-294.

24. Duan J, Wang S, Liu P, et al. Early prediction of noninvasive ventilation failure in COPD patients: derivation, internal validation, and external validation of a simple risk score. Ann Intensive Care. 2019;9(1):108.

25. Carrillo A, Lopez A, Carrillo L. Validity of a clinical scale in predicting the failure of non-invasive ventilation in hypoxemic patients. J Crit Care. 2020;60:152-158.

26. Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA. 2020;323(22):2329-2330.

27. Tobin MJ, Laghi F, Jubran A. P-SILI is not justification for intubation of COVID-19 patients. Ann Intensive Care. 2020;10:105.