ABSTRACT
The use of the high-flow nasal cannula (HFNC) for oxygen therapy in patients with acute hypoxemic respiratory failure has increased dramatically in recent years, owing to the numerous advantages it has over the other modalities. The respiratory rate-oxygenation (ROX) index was created as a monitoring tool for the appropriate use of the HFNC. It is gaining popularity as a critical monitoring tool due to its non-invasive nature and the ability to be performed at the bedside. To write this review we searched for the original peer-reviewed journal articles using search engines such as Cochrane Library, Google Scholar, and PubMed for evidence of the utility of this index in clinical practice. Despite having many advantages as well as limitations, the ROX index has been shown to have a moderate but useful predictive value/capacity and diagnostic accuracy in detecting HFNC-assisted oxygen therapy failure or success. Further high-quality prospective studies and trials might bring more clarity regarding performance under variable flow rates of HFNC, the acquisition time intervals, cut-off value/limit, and standardization of the index. The ROX index being a non-invasive, simple, and bedside tool could prove a very promising tool to assess the effectiveness, progress and outcome of the HFNC therapy.
ABSTRACT
PURPOSE: Although unexpected airway difficulties are reported in patients with mucormycosis, the literature on airway management in patients with mucormycosis associated with Coronavirus disease is sparse. METHODS: In this retrospective case record review of 57 patients who underwent surgery for mucormycosis associated with coronavirus disease, we aimed to evaluate the demographics, airway management, procedural data, and in-hospital mortality records. RESULTS: Forty-one (71.9%) patients had a diagnosis of sino-nasal mucormycosis, fourteen (24.6%) patients had a diagnosis of rhino-orbital mucormycosis, and 2 (3.5%) patients had a diagnosis of palatal mucormycosis. A total of 44 (77.2%) patients had co-morbidities. The most common co-morbidities were diabetes mellitus in 42 (73.6%) patients, followed by hypertension in 21 (36.8%) patients, and acute kidney injury in 14 (28.1%) patients. We used the intubation difficulty scale score to assess intubating conditions. Intubation was easy to slightly difficult in 53 (92.9%) patients. In our study, mortality occurred in 7 (12.3%) patients. The median (range) mortality time was 60 (27-74) days. The median (range) time to hospital discharge was 53.5 (10-85) days. The median [interquartile range] age of discharged versus expired patients was 47.5 [41,57.5] versus 64 [47,70] years (P = 0.04), and median (interquartile range) D-dimer levels in discharged versus expired patients was 364 [213, 638] versus 2448 [408,3301] ng/mL (P = 0.03). CONCLUSION: In patients undergoing surgery for mucormycosis associated with the coronavirus disease, airway management was easy to slightly difficult in most patients. Perioperative complications can be minimized by taking timely and precautionary measures.