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HACOR score to predict NIV failure in patients with COVID-related hypoxemic respiratory failure managed in the ordinary ward and in the critical care setting

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Abstract

We evaluated the prevalence of non-invasive ventilation (NIV) failure among patients with COVID-19-related pneumonia, managed in the ordinary ward and in the HDU/ICU and we tested the prognostic role of the HACOR score in those different settings. This is a retrospective study, conducted in the University-Hospital Careggi. We included all subjects with COVID-19 and ARF requiring NIV between March 2020 and May 2021, respectively managed in the ordinary ward (G1) and in the critical care setting (G2). Clinical parameters, HACOR and SOFA score were evaluated at Day 0 and after 1, 2 and 5 days of treatment. The primary outcome was NIV failure. 13% G1 patients and 40% G2 patients underwent endotracheal intubation (ETI). NIV was successful in 60% G1 AND 43% G2 patients (p < 0.001). In G1, compared to those with successful NIV, patients who underwent ETI, had a higher HACOR since the baseline evaluation (T0: 6 [5–6] vs 5 [3–6]; T1: 6 [5–6] vs 5 [3–6], all p < 0.05). An HACOR score > 5 was associated with an increased prevalence of ETI independent to an advanced age and a SOFA score > 5 both in G1 (T1: RR 4.87, 95% CI 1.462–16.275; T5: 3.630, 95% CI 0.979–13.462) and G2 (T0: 1.76, 95% CI 0.906–3.422; T1: 3.38, 95% CI 1.386–8.265). Among patients with COVID-related-ARF, NIV could be managed in the ordinary ward in a consistent proportion of patients and, among them, an HACOR score > 5 was independently associated with increased NIV failure from the earliest evaluations.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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References

  1. Tortola D, Magnani E, Giorgini E et al (2022) Managing complexity: the experience of an italian internal medicine unit during the SARS-CoV-2 pandemic, looking to the future. SN Compr Clin Med 4(1):233. https://doi.org/10.1007/s42399-022-01320-z

    Article  PubMed  PubMed Central  Google Scholar 

  2. Duca A, Memaj I, Zanardi F et al (2020) Severity of respiratory failure and outcome of patients needing a ventilatory support in the emergency department during Italian novel coronavirus SARS-CoV2 outbreak: preliminary data on the role of helmet CPAP and non-invasive positive pressure ventilation. EClinicalMedicine 24:100419. https://doi.org/10.1016/j.eclinm.2020.100419

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rochwerg B, Brochard L, Elliott MW et al (2017) Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. https://doi.org/10.1183/13993003.02426-2016

    Article  PubMed  Google Scholar 

  4. Grasselli G, Calfee CS, Camporota L et al (2023) ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med 49(7):727–759. https://doi.org/10.1007/s00134-023-07050-7

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brusasco C, Corradi F, Di Domenico A et al (2021) Continuous positive airway pressure in COVID-19 patients with moderate-to-severe respiratory failure. Eur Respir J. https://doi.org/10.1183/13993003.02524-2020

    Article  PubMed  PubMed Central  Google Scholar 

  6. Grieco DL, Menga LS, Raggi V et al (2020) Physiological comparison of high-flow nasal cannula and helmet noninvasive ventilation in acute hypoxemic respiratory failure. Am J Respir Crit Care Med 201(3):303–312. https://doi.org/10.1164/rccm.201904-0841OC

    Article  PubMed  Google Scholar 

  7. Aliberti S, Radovanovic D, Billi F et al (2020) Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicenter, cohort study. Eur Respir J. https://doi.org/10.1183/13993003.01935-2020

    Article  PubMed  PubMed Central  Google Scholar 

  8. Calligaro GL, Lalla U, Audley G et al (2020) The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: a multi-centre prospective observational study. EClinicalMedicine 28:100570. https://doi.org/10.1016/j.eclinm.2020.100570

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zucman N, Mullaert J, Roux D et al (2020) Prediction of outcome of nasal high flow use during COVID-19-related acute hypoxemic respiratory failure. Intensive Care Med 46(10):1924–1926. https://doi.org/10.1007/s00134-020-06177-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Innocenti F, Lazzari C, Paolucci E et al (2022) Role of prognostic scores in predicting in-hospital mortality and failure of non-invasive ventilation in adults with COVID-19. Intern Emerg Med 17(8):2367–2377. https://doi.org/10.1007/s11739-022-03058-x

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rodriguez M, Arrive F, Thille AW, Frat JP (2022) High-flow nasal oxygen in acute hypoxemic respiratory failure. Rev Mal Respir 39(7):607–617. https://doi.org/10.1016/j.rmr.2022.06.001

    Article  CAS  PubMed  Google Scholar 

  12. Duan J, Han X, Bai L, Zhou L, Huang S (2017) Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med 43(2):192–199. https://doi.org/10.1007/s00134-016-4601-3

    Article  CAS  PubMed  Google Scholar 

  13. Innocenti F, Tozzi C, Donnini C et al (2018) SOFA score in septic patients: incremental prognostic value over age, comorbidities, and parameters of sepsis severity. Intern Emerg Med 13(3):405–412. https://doi.org/10.1007/s11739-017-1629-5

    Article  PubMed  Google Scholar 

  14. Fiorino S, Bacchi-Reggiani L, Detotto E et al (2015) Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study. Intern Med J 45(5):527–537. https://doi.org/10.1111/imj.12726

    Article  CAS  PubMed  Google Scholar 

  15. Sainaghi PP, Colombo D, Re A et al (2016) Natural history and risk stratification of patients undergoing non-invasive ventilation in a non-ICU setting for severe COPD exacerbations. Intern Emerg Med 11(7):969–975. https://doi.org/10.1007/s11739-016-1473-z

    Article  PubMed  Google Scholar 

  16. Beloncle FM (2023) Is COVID-19 different from other causes of acute respiratory distress syndrome? J Intensive Med 3(3):212–219. https://doi.org/10.1016/j.jointm.2023.02.003

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gattinoni L, Chiumello D, Rossi S (2020) COVID-19 pneumonia: ARDS or not? Crit Care 24(1):154. https://doi.org/10.1186/s13054-020-02880-z

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tobin MJ, Jubran A, Laghi F (2020) Noninvasive strategies in COVID-19: epistemology, randomised trials, guidelines, physiology. Eur Respir J. https://doi.org/10.1183/13993003.04247-2020

    Article  Google Scholar 

  19. Perkins GD, Ji C, Connolly BA et al (2022) Effect of noninvasive respiratory strategies on intubation or mortality among patients with acute hypoxemic respiratory failure and COVID-19: the RECOVERY-RS randomized clinical trial. JAMA 327(6):546–558. https://doi.org/10.1001/jama.2022.0028

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Guia MF, Boleo-Tome JP, Imitazione P et al (2021) Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia. Respir Med 187:106550. https://doi.org/10.1016/j.rmed.2021.106550

    Article  PubMed  PubMed Central  Google Scholar 

  21. Innocenti F, Giordano L, Gualtieri S et al (2020) Prediction of mortality with the use of noninvasive ventilation for acute respiratory failure. Respir Care. https://doi.org/10.4187/respcare.07464

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy

    Francesco Pepe, Ginevra Fabiani, Carolina Cogozzo, Valerio Mazzilli, Maurizio Villanti, Riccardo Pini & Francesca Innocenti

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  1. Francesco Pepe
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  2. Ginevra Fabiani
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  3. Carolina Cogozzo
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  4. Valerio Mazzilli
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  5. Maurizio Villanti
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  6. Riccardo Pini
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  7. Francesca Innocenti
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Contributions

Francesco Pepe and Francesca Innocenti gave substantial contributions to the conception and design of the work; Carolina Cogozzo, Valerio Mazzilli and Maurizio Villanti gave substantial contributions in the acquisition, and analysis of data for the work; Ginevra Fabiani and Francesco Pepe drafted the manuscript and Riccardo Pini revised it critically for important intellectual content. Francesca Innocenti gave the final approval of the version to be published.

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Correspondence to Francesca Innocenti.

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The study protocol was approved by the “Toscana—Area Vasta—Centro” inter-institutional ethic committee (registration number OSS.13.031) and was conducted in accordance with the Helsinki Declaration of 1964 (revised 2008).

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Retrospective study.

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Pepe, F., Fabiani, G., Cogozzo, C. et al. HACOR score to predict NIV failure in patients with COVID-related hypoxemic respiratory failure managed in the ordinary ward and in the critical care setting. Intern Emerg Med (2024). https://doi.org/10.1007/s11739-024-03628-1

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  • DOI: https://doi.org/10.1007/s11739-024-03628-1

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