TY - JOUR
T1 - Diaphragmatic Ultrasound Predictors of High-Flow Nasal Cannula Therapeutic Failure in Critically Ill Patients With SARS-CoV-2 Pneumonia
AU - Bruna, Mario
AU - Hidalgo, Gabriela
AU - Castañeda, Sebastian
AU - Galvez, Miguel
AU - Bravo, Diego
AU - Benitez, Rodrigo
AU - Tobar, Rodolfo
AU - Quevedo, José
AU - Rodríguez, José
AU - Murua, Camila
AU - Madariaga, Rafael
AU - Benavides, Claudia
AU - Huilcaman, Marcos
AU - Martinez, Felipe
AU - Retamal, Jaime
AU - Kattan, Eduardo
N1 - Publisher Copyright:
© 2022 American Institute of Ultrasound in Medicine.
PY - 2022
Y1 - 2022
N2 - Objectives: High flow nasal cannula (HFNC) is frequently used in patients with acute respiratory failure, but there is limited evidence regarding predictors of therapeutic failure. The objective of this study was to assess diaphragmatic ultrasound criteria as predictors of failure to HFNC, defined as the need for orotracheal intubation or death. Methods: Prospective cohort study including adult patients consecutively admitted to the critical care unit, from July 24 to October 20, 2020, with respiratory failure secondary to SARS-CoV-2 pneumonia who required HFNC. After 12 hours of HFNC initiation we measured ROX index (ratio of SpO2/FiO2 to respiratory rate), excursion and diaphragmatic contraction speed (diaphragmatic excursion/inspiratory time) by ultrasound, both in supine and prone position. Results: In total, 41 patients were analyzed, 25 succeeded and 16 failed HFNC therapy. At 12 hours, patients who succeeded HFNC therapy presented higher ROX index in supine position (9.8 [9.1–15.6] versus 5.4 [3.9–6.8], P <.01), and higher PaO2/FiO2 ratio (186 [135–236] versus 117 [103–162] mmHg, P =.03). To predict therapeutic failure, the supine diaphragmatic contraction speed presented sensitivity of 89% and a specificity of 57%, while the ROX index presented a sensitivity of 92.8% and a specificity of 75%. Conclusions: Diaphragmatic contraction speed by ultrasound emerges as a diagnostic complement to clinical tools to predict HFNC success. Future studies should confirm these results.
AB - Objectives: High flow nasal cannula (HFNC) is frequently used in patients with acute respiratory failure, but there is limited evidence regarding predictors of therapeutic failure. The objective of this study was to assess diaphragmatic ultrasound criteria as predictors of failure to HFNC, defined as the need for orotracheal intubation or death. Methods: Prospective cohort study including adult patients consecutively admitted to the critical care unit, from July 24 to October 20, 2020, with respiratory failure secondary to SARS-CoV-2 pneumonia who required HFNC. After 12 hours of HFNC initiation we measured ROX index (ratio of SpO2/FiO2 to respiratory rate), excursion and diaphragmatic contraction speed (diaphragmatic excursion/inspiratory time) by ultrasound, both in supine and prone position. Results: In total, 41 patients were analyzed, 25 succeeded and 16 failed HFNC therapy. At 12 hours, patients who succeeded HFNC therapy presented higher ROX index in supine position (9.8 [9.1–15.6] versus 5.4 [3.9–6.8], P <.01), and higher PaO2/FiO2 ratio (186 [135–236] versus 117 [103–162] mmHg, P =.03). To predict therapeutic failure, the supine diaphragmatic contraction speed presented sensitivity of 89% and a specificity of 57%, while the ROX index presented a sensitivity of 92.8% and a specificity of 75%. Conclusions: Diaphragmatic contraction speed by ultrasound emerges as a diagnostic complement to clinical tools to predict HFNC success. Future studies should confirm these results.
KW - COVID-19 pneumonia
KW - diaphragmatic ultrasound
KW - high flow nasal cannula
KW - ROX index
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85142931155&partnerID=8YFLogxK
U2 - 10.1002/jum.16141
DO - 10.1002/jum.16141
M3 - Article
AN - SCOPUS:85142931155
SN - 0278-4297
JO - Journal of Ultrasound in Medicine
JF - Journal of Ultrasound in Medicine
ER -