Factors predictors del fracàs dels suports respiratoris no invasius en la pneumònia COVID-19

Abstract

Patients with acute hypoxemic respiratory failure due to COVID-19 undergoing high-flow therapy before intubation present a greater risk of mortality when intubation is delayed. We have designed a prospective study that looks for biomarkers for the early prediction of high-flow failure. An analytical blood value could be more stable than the ROX index since it will not depend on the patient's vital signs at that time. We define failure of high flow as the need to escalate the treatment to non-invasive positive pressure ventilation. 139 patients were recruited into the study. The Pearson chi-square test was used to compare the main results of the study. These include the incidence of intubation, the cumulative incidence of mortality at 30 days, the cumulative incidence of mortality at 1 year, and the composite result of intubation or death at the end of the trial. The Kaplan-Meyer curve was used to illustrate the time to high-flow failure. The Cox regression model was used to estimate predictors of high-flow failure for all parameters. Lower levels of bicarbonate, thrombocytopenia, and higher levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), creatinine, and glucose are early blood biomarkers independently associated with high flow failure. CPAP and VMNI systems were compared among patients who failed in high flow and no statistically significant differences were found between both therapies. As a limitation of the study, a sufficiently large study population has not been reached to find differences between groups. External validations with other cohorts and multicenter studies with larger participants are needed to corroborate these findings.

Date of Award	22 Nov 2024
Original language	Catalan
Supervisor	Irene Aldas Criado (Director) & Antoni Rosell Gratacos (Director)