Abstract
To replace mechanical ventilation (MV), which represents the cornerstone therapy in severe COVID-19 cases, high-flow nasal oxygen (HFNO) therapy has recently emerged as a less-invasive therapeutic possibility for those patients. Respecting the risk of MV delay as a result of HFNO use, we aimed to evaluate which parameters could determine the risk of in-hospital mortality in HFNO-treated COVID-19 patients. This single-center cohort study included 102 COVID-19-positive patients treated with HFNO. Standard therapeutic methods and up-to-date protocols were used. Patients who underwent a fatal event (41.2%) were significantly older, mostly male patients, and had higher comorbidity burdens measured by CCI. In a univariate analysis, older age, shorter HFNO duration, ventilator initiation, higher CCI and lower ROX index all emerged as significant predictors of adverse events (p < 0.05). Variables were dichotomized and included in the multivariate analysis to define their relative weights in the computed risk score model. Based on this, a risk score model for the prediction of in-hospital mortality in COVID-19 patients treated with HFNO consisting of four variables was defined: CCI > 4, ROX index ≤ 4.11, LDH-to-WBC ratio, age > 65 years (CROW-65). The main purpose of CROW-65 is to address whether HFNO should be initiated in the subgroup of patients with a high risk of in-hospital mortality.
Highlights
Ever since the COVID-19 pandemic reached its peak in March 2020, intensivists around the world have been struggling to establish the optimal approach for the treatment of its life-threatening complications [1]
We aimed to evaluate which parameters could determine the risk of in-hospital mortality in HFNOtreated COVID-19 patients
The rates of high-flow nasal oxygen (HFNO) failure and mortality were generally high in this single-center study, but concordant with most of the available data
Summary
Ever since the COVID-19 pandemic reached its peak in March 2020, intensivists around the world have been struggling to establish the optimal approach for the treatment of its life-threatening complications [1]. The COVID-19 pandemic has had major implications for the global economy, which resulted in harmful repercussions for healthcare systems around the world [7]. This is especially noticeable in poverty-stricken areas, since in those areas, the lack of resources has been a major determinant of disease prognosis since even before the pandemic [7]. An early intubation approach has been proposed [15] This approach has been backed up by multiple studies in patients with acute respiratory distress syndrome (ARDS), conducted in the pre-COVID era [16,17]. Despite substantial developments in our understanding and managing of the detrimental effects of invasive ventilation, patients whose treatment results in intubation have very poor prognosis, even in the most reputable medical centers [18,19]
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