Cargando…

Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India

Background: Non-invasive oxygen therapy (NIT) consists of high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP). NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. However, previo...

Descripción completa

Detalles Bibliográficos
Autores principales: L, Sekar, Sehgal, Inderpaul S, Kajal, Kamal, Kataria, Sandeep, Premkumar, Madhumita, Singla, Karan, Mahajan, Varun, Gorla, Deep K, Puri, Goverdhan D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9627106/
https://www.ncbi.nlm.nih.gov/pubmed/36340560
http://dx.doi.org/10.7759/cureus.29721
_version_ 1784822890507534336
author L, Sekar
Sehgal, Inderpaul S
Kajal, Kamal
Kataria, Sandeep
Premkumar, Madhumita
Singla, Karan
Mahajan, Varun
Gorla, Deep K
Puri, Goverdhan D
author_facet L, Sekar
Sehgal, Inderpaul S
Kajal, Kamal
Kataria, Sandeep
Premkumar, Madhumita
Singla, Karan
Mahajan, Varun
Gorla, Deep K
Puri, Goverdhan D
author_sort L, Sekar
collection PubMed
description Background: Non-invasive oxygen therapy (NIT) consists of high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP). NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. However, previously published studies show that NIT failure might delay endotracheal intubation and invasive mechanical ventilation and results in worse outcomes in patients with hypoxemic respiratory failure. Early prediction of failure of NIT, will help in early decision-making in initiating invasive mechanical ventilation. We retrospectively studied the predictors for NIT failure in patients with moderate to severe COVID-19. Methods: Adult patients (>18 years) admitted to the intensive care unit (ICU) with moderate to severe COVID-19 ARDS and received NIT [HFNO and CPAP non-invasive ventilation (NIV)] were included in this study. Baseline clinical and laboratory data were collected retrospectively from the electronic hospital information system. NIT failure was defined as the need for invasive mechanical ventilation after the initiation of NIT in the ICU. Univariate and multivariate logistic regression analyses were used to find out the possible predictors of NIT failure. Results: Out of 254 patients admitted to ICU, 127 patients were initiated NIT at admission to ICU. During the course of the ICU stay, 33 (26%) patients subsequently required invasive mechanical ventilation (NIT failure). Respiratory rate-oxygenation index (ROX index) of <2.97 at two hours and <3.63 at six hours of ICU admission predicted NIT failure in our cohort of patients with a high positive predictive value. Conclusion: Patient selection is crucial for successful NIT in COVID-19. Application of ROX index measured in the first six hours of ICU admission helps in the identification of patients at risk of NIT failure with moderate to severe COVID-19 ARDS.
format Online
Article
Text
id pubmed-9627106
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-96271062022-11-04 Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India L, Sekar Sehgal, Inderpaul S Kajal, Kamal Kataria, Sandeep Premkumar, Madhumita Singla, Karan Mahajan, Varun Gorla, Deep K Puri, Goverdhan D Cureus Anesthesiology Background: Non-invasive oxygen therapy (NIT) consists of high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP). NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. However, previously published studies show that NIT failure might delay endotracheal intubation and invasive mechanical ventilation and results in worse outcomes in patients with hypoxemic respiratory failure. Early prediction of failure of NIT, will help in early decision-making in initiating invasive mechanical ventilation. We retrospectively studied the predictors for NIT failure in patients with moderate to severe COVID-19. Methods: Adult patients (>18 years) admitted to the intensive care unit (ICU) with moderate to severe COVID-19 ARDS and received NIT [HFNO and CPAP non-invasive ventilation (NIV)] were included in this study. Baseline clinical and laboratory data were collected retrospectively from the electronic hospital information system. NIT failure was defined as the need for invasive mechanical ventilation after the initiation of NIT in the ICU. Univariate and multivariate logistic regression analyses were used to find out the possible predictors of NIT failure. Results: Out of 254 patients admitted to ICU, 127 patients were initiated NIT at admission to ICU. During the course of the ICU stay, 33 (26%) patients subsequently required invasive mechanical ventilation (NIT failure). Respiratory rate-oxygenation index (ROX index) of <2.97 at two hours and <3.63 at six hours of ICU admission predicted NIT failure in our cohort of patients with a high positive predictive value. Conclusion: Patient selection is crucial for successful NIT in COVID-19. Application of ROX index measured in the first six hours of ICU admission helps in the identification of patients at risk of NIT failure with moderate to severe COVID-19 ARDS. Cureus 2022-09-28 /pmc/articles/PMC9627106/ /pubmed/36340560 http://dx.doi.org/10.7759/cureus.29721 Text en Copyright © 2022, L et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
L, Sekar
Sehgal, Inderpaul S
Kajal, Kamal
Kataria, Sandeep
Premkumar, Madhumita
Singla, Karan
Mahajan, Varun
Gorla, Deep K
Puri, Goverdhan D
Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India
title Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India
title_full Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India
title_fullStr Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India
title_full_unstemmed Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India
title_short Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India
title_sort factors associated with non-invasive oxygen therapy failure in covid-19 pneumonia: a single center, retrospective study in a tertiary hospital in north india
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9627106/
https://www.ncbi.nlm.nih.gov/pubmed/36340560
http://dx.doi.org/10.7759/cureus.29721
work_keys_str_mv AT lsekar factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT sehgalinderpauls factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT kajalkamal factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT katariasandeep factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT premkumarmadhumita factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT singlakaran factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT mahajanvarun factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT gorladeepk factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia
AT purigoverdhand factorsassociatedwithnoninvasiveoxygentherapyfailureincovid19pneumoniaasinglecenterretrospectivestudyinatertiaryhospitalinnorthindia