/RR) may predict HFNC outcomes better. However, up to now, limited data are available on the effectiveness of the mROX index, and the potential of the mROX index achieving a better predictive value to avoid intubation at an early phase after HFNC therapy remains unclear. Therefore, this study was designed to explore the ability of the mROX index to predict HFNC therapy outcomes in patients with AHRF at an early phase.
Adult patients admitted to the ICU due to AHRF receiving HFNC therapy were included. Patients with incomplete data, those who were discharged from the hospital after giving up further treatment, and those within the perinatal period were excluded.AHRF is defined as having an RR of more than 25 breaths/min and a P/F ratio of less than 300 mmHg on an oxygen device delivering ≥ 10 L/min, in the absence of chronic respiratory failure and hypercapnia.
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Lung ultrasound response to awake prone positioning predicts the need for intubation in patients with COVID-19 induced acute hypoxemic respiratory failure: an observational study - Critical CareBackground Awake prone positioning (APP) reduces the intubation rate in COVID-19 patients treated by high-flow nasal cannula (HFNC). However, the lung aeration response to APP has not been addressed. We aimed to explore the lung aeration response to APP by lung ultrasound (LUS). Methods This two-center, prospective, observational study enrolled patients with COVID-19-induced acute hypoxemic respiratory failure treated by HFNC and APP. LUS score was recorded 5–10 min before, 1 h after APP, and 5–10 min after supine in the first APP session within the first three days. The primary outcome was LUS score changes in the first three days. Secondary outcomes included changes in SpO2/FiO2 ratio, respiratory rate and ROX index (SpO2/FiO2/respiratory rate) related to APP, and the rate of treatment success (patients who avoided intubation). Results Seventy-one patients were enrolled. LUS score decreased from 20 (interquartile range [IQR] 19–24) to 19 (18–21) (p 1 after the first APP session was associated with decreased risk for intubation (Relative risk 0.25 [0.09–0.69]). APP daily duration was correlated with LUS score reduction in patients with treatment success, especially in dorsal lung zones (r = − 0.76; p | 0.001). Conclusions In patients with acute hypoxemic respiratory failure due to COVID-19 and treated by HFNC, APP reduced LUS score. The reduction in dorsal LUS scores after APP was associated with treatment success. The longer duration on APP was correlated with greater lung aeration. Trial registration This study was prospectively registered on clinicaltrials.gov on April 22, 2021. Identification number NCT04855162 .
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