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Celejewska-Wójcik N, Polok K, Górka K, Stachura T, Kania A, Nastałek P, Lichołai S, Zastrzeżyńska W, Przybyszowski M, Sładek K. Association between undiagnosed obstructive sleep apnea and severe course of COVID-19: a prospective observational study. Sleep Breath 2024; 28:79-86. [PMID: 37418221 PMCID: PMC10954863 DOI: 10.1007/s11325-023-02855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with many long-term health consequences. We hypothesized that previously unrecognized and untreated OSA may be associated with more severe respiratory failure in hospitalized patients with COVID-19. METHODS Patients hospitalized in the Pulmonology Department with confirmed COVID-19, University Hospital in Kraków, Poland, between September 2020 and April 2021 were enrolled. OSA screening questionnaires including Epworth Sleepiness Scale (ESS), STOP-BANG, Berlin questionaire (BQ), OSA-50, and No-SAS were completed. Polygraphy was performed after > 24 h without requirement for supplemental oxygen. RESULTS Of 125 patients with median age of 61.0 years, 71% of whom were male. OSA was diagnosed in 103 patients (82%) and was categorized as mild, moderate, and severe in 41 (33%), 30 (24%), and 32 (26%), respectively. Advanced respiratory support was introduced in 85 patients (68%), and 8 (7%) patients eventually required intubation. Multivariable analysis revealed that increased risk of requirement for advanced respiratory support was associated with higher respiratory event index (OR 1.03, 95%CI 1.00 to 1.07), oxygen desaturation index (OR 1.05, 95%CI 1.02 to 1.10), and hypoxic burden (1.02 95% CI 1.00 to 1.03) and lower minimal SpO2 (OR 0.89, 95%CI 0.81 to 0.98), but not with results of OSA screening tools like BQ score (OR 0.66, 95%CI 0.38 to 1.16), STOP-BANG score (OR 0.73, 95%CI 0.51 to 1.01), NoSAS score (OR 1.01, 95%CI 0.87 to 1.18), or OSA50 score (OR 0.84, 95%CI 0.70 to 1.01). CONCLUSION Previously undiagnosed OSA was common among hospitalized patients who survived the acute phase of COVID-19. The degree of OSA was associated with the severity of respiratory failure.
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Affiliation(s)
- Natalia Celejewska-Wójcik
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland.
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Kamil Polok
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Górka
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Stachura
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksander Kania
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Nastałek
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Sabina Lichołai
- Division of Molecular Biology and Clinical Genetics, Department of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Weronika Zastrzeżyńska
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Przybyszowski
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Sładek
- Department of Pulmonology and Allergology, University Hospital, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
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Bianchi M. The effects of high-flow oxygen therapy on mortality in patients with COVID-19. J Am Assoc Nurse Pract 2023; 35:183-191. [PMID: 36729579 DOI: 10.1097/jxx.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND High-flow oxygen therapy (HFOT) has been successful in treating acute hypoxic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS). Successful treatment with noninvasive ventilation and avoidance of mechanical ventilation (MV) has been associated with decreased mortality and positive patient outcomes. It is unclear whether the evidence supports the use of HFOT to treat coronavirus disease 2019 (COVID-19)-induced AHRF and ARDS. OBJECTIVES To determine whether the use of HFOT decreases the need for intubation or decreases mortality compared with MV in patients with AHRF due to COVID-19. DATA SOURCES A literature search was conducted in March 2022 using CINAHL, Embase, PubMed, and Scopus bibliographic databases. Ten studies comparing HFOT and MV in COVID-19 respiratory failure met inclusion criteria. CONCLUSIONS Nine studies found a statistically significant reduction in the need for intubation; eight studies found significantly decreased morality in patients who received HFOT. Study design and methodologies limited the findings. IMPLICATIONS FOR PRACTICE Based on the available evidence, the use of HFOT positively affected mortality and incidence of the need for intubation and MV. Further research needs to be conducted before HFOT is adopted as the standard of care for COVID-19-induced AHRF and ARDS. Nurse practitioners should be informed regarding the various respiratory support modalities and evaluate risk versus benefit when caring for patients with COVID-19-induced AHRF and ARDS.
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Affiliation(s)
- Mia Bianchi
- University of Pennsylvania, School of Nursing, Adult Gerontology Acute Care Nurse Practitioner Program, Philadelphia, Pennsylvania
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Weerakkody S, Arina P, Glenister J, Cottrell S, Boscaini-Gilroy G, Singer M, Montgomery HE. Non-invasive respiratory support in the management of acute COVID-19 pneumonia: considerations for clinical practice and priorities for research. THE LANCET. RESPIRATORY MEDICINE 2022; 10:199-213. [PMID: 34767767 PMCID: PMC8577844 DOI: 10.1016/s2213-2600(21)00414-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
Non-invasive respiratory support (NIRS) has increasingly been used in the management of COVID-19-associated acute respiratory failure, but questions remain about the utility, safety, and outcome benefit of NIRS strategies. We identified two randomised controlled trials and 83 observational studies, compromising 13 931 patients, that examined the effects of NIRS modalities-high-flow nasal oxygen, continuous positive airway pressure, and bilevel positive airway pressure-on patients with COVID-19. Of 5120 patients who were candidates for full treatment escalation, 1880 (37%) progressed to invasive mechanical ventilation and 3658 of 4669 (78%) survived to study end. Survival was 30% among the 1050 patients for whom NIRS was the stated ceiling of treatment. The two randomised controlled trials indicate superiority of non-invasive ventilation over high-flow nasal oxygen in reducing the need for intubation. Reported complication rates were low. Overall, the studies indicate that NIRS in patients with COVID-19 is safe, improves resource utilisation, and might be associated with better outcomes. To guide clinical decision making, prospective, randomised studies are needed to address timing of intervention, optimal use of NIRS modalities-alone or in combination-and validation of tools such as oxygenation indices, response to a trial of NIRS, and inflammatory markers as predictors of treatment success.
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Affiliation(s)
- Sampath Weerakkody
- Centre for Human Health and Performance, Institute of Sport, Exercise and Health, Division of Medicine, University College London, London, UK.
| | - Pietro Arina
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK,University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Sam Cottrell
- Digital Publishing, Office for National Statistics, Fareham, Hampshire, UK
| | | | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK,University College London Hospitals NHS Foundation Trust, London, UK
| | - Hugh E Montgomery
- Centre for Human Health and Performance, Institute of Sport, Exercise and Health, Division of Medicine, University College London, London, UK,The Whittington Health NHS Foundation Trust, London, UK
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Leszek A, Wozniak H, Giudicelli-Bailly A, Suh N, Boroli F, Pugin J, Grosgurin O, Marti C, Le Terrier C, Quintard H. Early Measurement of ROX Index in Intermediary Care Unit Is Associated with Mortality in Intubated COVID-19 Patients: A Retrospective Study. J Clin Med 2022; 11:jcm11020365. [PMID: 35054058 PMCID: PMC8779507 DOI: 10.3390/jcm11020365] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
COVID-19 patients often present with rapidly progressing acute hypoxemic respiratory failure, requiring orotracheal intubation with different prognostic issues. However, ICU specialists lack predictive tools to stratify these patients. We conducted a single-center cross-sectional retrospective study to evaluate if the ROX index, measured under non-invasive oxygenation support, can predict ICU mortality in a COVID-19 intubated patient cohort. This study took place in the division of intensive care at the Geneva University Hospitals (Geneva, Switzerland). We included all consecutive adult patients treated by non-invasive oxygenation support and requiring intubation for acute respiratory failure due to COVID-19 between 9 September 2020 and 30 March 2021, corresponding to the second local surge of COVID-19 cases. Baseline demographic data, comorbidities, median ROX between H0 and H8, and clinical outcomes were collected. Overall, 82 patients were intubated after failing a non-invasive oxygenation procedure. Women represented 25.6% of the whole cohort. Median age and median BMI were 70 (60–75) years and 28 (25–33), respectively. Before intubation, the median ROX between H0 and H8 was 6.3 (5.0–8.2). In a multivariate analysis, the median ROX H0–H8 was associated with ICU mortality as a protective factor with an odds ratio (95% CI) = 0.77 (0.60–0.99); p < 0.05. In intubated COVID-19 patients treated initially by non-invasive oxygenation support for acute respiratory failure, the median ROX H0–H8 could be an interesting predictive factor associated with ICU mortality.
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Affiliation(s)
- Alexandre Leszek
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (A.L.); (O.G.); (C.M.)
| | - Hannah Wozniak
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Amélie Giudicelli-Bailly
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Noémie Suh
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Filippo Boroli
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Jérôme Pugin
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Olivier Grosgurin
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (A.L.); (O.G.); (C.M.)
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Christophe Marti
- Department of Medicine, Division of General Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland; (A.L.); (O.G.); (C.M.)
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Christophe Le Terrier
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
| | - Hervé Quintard
- Department of Acute Medicine, Intensive Care Unit, Geneva University Hospitals, 1205 Geneva, Switzerland; (H.W.); (A.G.-B.); (N.S.); (F.B.); (J.P.); (C.L.T.)
- Correspondence:
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Xu DY, Dai B, Tan W, Zhao HW, Wang W, Kang J. Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis. Ther Adv Respir Dis 2022; 16:17534666221091931. [PMID: 35467449 PMCID: PMC9047804 DOI: 10.1177/17534666221091931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients
with severe cases have received oxygen therapy through a high-flow nasal
cannula (HFNC). Objectives: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk
factors for HFNC failure. Methods: We searched PubMed, Embase, and the Cochrane Central Register of randomized
controlled trials (RCTs) and observational studies of HFNC in patients with
COVID-19 published in English from January 1st, 2020 to August 15th, 2021.
The primary aim was to assess intubation, mortality, and failure rates in
COVID-19 patients supported by HFNC. Secondary aims were to compare HFNC
success and failure groups and to describe the risk factors for HFNC
failure. Results: A total of 25 studies fulfilled selection criteria and included 2851
patients. The intubation, mortality, and failure rates were 0.44 (95%
confidence interval (CI): 0.38–0.51, I2 = 84%), 0.23 (95% CI:
0.19–0.29, I2 = 88%), and 0.47 (95% CI: 0.42–0.51,
I2 = 56%), respectively. Compared to the success group, age, body
mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute
Physiology and Chronic Health Evaluation (APACHE) II score, D-dimer,
lactate, heart rate, and respiratory rate were higher and PaO2,
PaO2/FiO2, ROX index (the ratio of
SpO2/FiO2 to respiratory rate), ROX index after
the initiation of HFNC, and duration of HFNC were lower in the failure group
(all Ps < 0.05). There were also more smokers and more comorbidities in
the failure group (all Ps < 0.05). Pooled odds ratios (ORs) revealed that
older age (OR: 1.04, 95% CI: 1.01–1.07, P = 0.02, I2 = 88%), a
higher white blood cell (WBC) count (OR: 1.06, 95% CI: 1.01–1.12, P = 0.02,
I2 = 0%), a higher heart rate (OR: 1.42, 95% CI: 1.15–1.76,
P < 0.01, I2 = 0%), and a lower ROX index(OR: 0.61, 95% CI:
0.39–0.95, P = 0.03, I2 = 93%) after the initiation of HFNC were
all significant risk factors for HFNC failure. Conclusions: HFNC is an effective way of providing respiratory support in the treatment of
COVID-19 patients. Older age, a higher WBC count, a higher heart rate, and a
lower ROX index after the initiation of HFNC are associated with an
increased risk of HFNC failure.
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Affiliation(s)
- Dong-Yang Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001 China
| | - Wei Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, China
| | - Hong-Wen Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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When Conventional Oxygen Therapy Fails-The Effectiveness of High-Flow Nasal Oxygen Therapy in Patients with Respiratory Failure in the Course of COVID-19. J Clin Med 2021; 10:jcm10204751. [PMID: 34682874 PMCID: PMC8541059 DOI: 10.3390/jcm10204751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
High-flow nasal oxygen (HFNO) is recommended as a first-line treatment in patients with acute hypoxemic respiratory failure due to COVID-19. We assessed the effectiveness of HFNO and predictors of failure and death. The medical records of 200 consecutive adult patients treated with HFNO were analysed. Ninety-two patients (46%) were successfully cured, 52 (26%) required noninvasive ventilation, and 61 (30.5%) received intubation. Overall mortality was 40.5%. Risk factors of HFNO ineffectiveness were: SpO2 ≤ 90% with conventional oxygen therapy (HR 0.32, 95% CI 0.19–0.53, p < 0.001), SpO2 ≤ 74% without oxygen therapy (HR 0.44, 95% CI 0.27–0.71, p < 0.001), an age ≥ 60, comorbidities, biomarkers (C-reactive protein, procalcitonin, creatinine, lactate dehydrogenase), duration of symptoms before admission to hospital ≤ 9 days, start of treatment with HFNO ≤ 4 days. The multivariate logistic regression models (age ≥ 60, comorbidities, C-reactive protein concentration and SpO2 with oxygen therapy) revealed a high predictive value of death and HFNO failure (AUC 0.851, sensitivity 0.780, specificity 0.802; AUC 0.800, sensitivity 0.776, specificity 0.739, respectively). HFNO is a safe method for treating acute hypoxemic respiratory failure, with effectiveness reaching nearly 50%. Low values of SpO2 without and during oxygen therapy seem to be good diagnostic tools for predicting death and HFNO failure.
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