TY - JOUR
T1 - A new non-invasive index for the prediction of endotracheal intubation in patients with SARS COVID-19 infection, in the emergency department, pilot study
AU - Jaramillo, Germán Devia
AU - Sanabria, Luis Carlos Venegas
AU - Buitrago, Carolina
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2023/4/21
Y1 - 2023/4/21
N2 - Background: In the current context of the SARS COVID-19 pandemic, where the main cause of death is respiratory failure, and since early recognition would allow timely measures to be implemented and probably improve outcomes, it is important to have tools that allow the emergency room to predict quickly and without the use of large resources which will need invasive mechanical ventilation. This study proposes using a new predictive index of noninvasive characteristics, based on the relationship between oxygenation and work of breathing measured by ultrasound-assessed diaphragmatic function, for the need for invasive mechanical ventilation in patients with SARS-COV2 infection who are admitted to the emergency department. Methods: A prospective predictive cohort study was performed, collecting all patients admitted to the emergency room with respiratory failure (not severe or in imminent respiratory arrest) and a confirmed diagnosis of SARS-CoV-2 pneumonia. Diaphragmatic excursion measurements were taken within the first 24 h after admission to the department. The relationship between diaphragmatic excursion and SAFI was calculated, establishing the ultrasound diaphragmatic excursion So2/FiO2 index (U.D.E.S.I). The index’s performance was determined by analysis of sensitivity, specificity, and area under the curve (AUC). Results: This pilot study analyzed the first 100 patients enrolled and found in-hospital mortality of 19%, all patients who died required mechanical ventilation, the right index showed a specificity of 82.4% with a sensitivity of 76.9%, likewise for the left index an overall specificity of 90.5% with a sensitivity of 65.3% was found. The ideal cut-off point for the right index is 1.485, and for the left index, the threshold point was 1.856. AUC of the right index is 0.798 (0.676–0.920) and of the left index 0.793 (0.674–0.911), when comparing them no significant differences were found between these values p = 0.871. Conclusion: The relationship of So2/FiO2 and diaphragm excursion measured by both right and left ultrasound could predict the need for mechanical ventilation of the patient with COVID-19 pneumonia in the emergency room and could constitute a valuable tool since it uses noninvasive parameters and is easily applicable at the patient’s bedside. However, a more extensive study is needed to validate these preliminary results.
AB - Background: In the current context of the SARS COVID-19 pandemic, where the main cause of death is respiratory failure, and since early recognition would allow timely measures to be implemented and probably improve outcomes, it is important to have tools that allow the emergency room to predict quickly and without the use of large resources which will need invasive mechanical ventilation. This study proposes using a new predictive index of noninvasive characteristics, based on the relationship between oxygenation and work of breathing measured by ultrasound-assessed diaphragmatic function, for the need for invasive mechanical ventilation in patients with SARS-COV2 infection who are admitted to the emergency department. Methods: A prospective predictive cohort study was performed, collecting all patients admitted to the emergency room with respiratory failure (not severe or in imminent respiratory arrest) and a confirmed diagnosis of SARS-CoV-2 pneumonia. Diaphragmatic excursion measurements were taken within the first 24 h after admission to the department. The relationship between diaphragmatic excursion and SAFI was calculated, establishing the ultrasound diaphragmatic excursion So2/FiO2 index (U.D.E.S.I). The index’s performance was determined by analysis of sensitivity, specificity, and area under the curve (AUC). Results: This pilot study analyzed the first 100 patients enrolled and found in-hospital mortality of 19%, all patients who died required mechanical ventilation, the right index showed a specificity of 82.4% with a sensitivity of 76.9%, likewise for the left index an overall specificity of 90.5% with a sensitivity of 65.3% was found. The ideal cut-off point for the right index is 1.485, and for the left index, the threshold point was 1.856. AUC of the right index is 0.798 (0.676–0.920) and of the left index 0.793 (0.674–0.911), when comparing them no significant differences were found between these values p = 0.871. Conclusion: The relationship of So2/FiO2 and diaphragm excursion measured by both right and left ultrasound could predict the need for mechanical ventilation of the patient with COVID-19 pneumonia in the emergency room and could constitute a valuable tool since it uses noninvasive parameters and is easily applicable at the patient’s bedside. However, a more extensive study is needed to validate these preliminary results.
KW - COVID-19
KW - Emergency
KW - Lung ultrasound
KW - POCUS
KW - Respiratory Insufficiency
KW - Emergency Service, Hospital
KW - Oxygen
KW - Pandemics
KW - Prospective Studies
KW - Humans
KW - Pilot Projects
KW - SARS-CoV-2
KW - RNA, Viral
KW - Respiration, Artificial/methods
KW - COVID-19/therapy
KW - Intubation, Intratracheal
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85153541464&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/f33b7389-5059-3206-97c7-0cbb037e616e/
U2 - 10.1186/s12890-023-02435-2
DO - 10.1186/s12890-023-02435-2
M3 - Artículo
C2 - 37085839
AN - SCOPUS:85153541464
SN - 1471-2466
VL - 23
SP - 135
JO - BMC Pulmonary Medicine
JF - BMC Pulmonary Medicine
IS - 1
M1 - 135
ER -