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Respir Med ; 187: 106550, 2021 10.
Article in English | MEDLINE | ID: mdl-34333389

ABSTRACT

INTRODUCTION: In COVID-19 associated hypoxemic acute respiratory failure (ARF) without mandatory indication for urgent endotracheal intubation, a trial of CPAP may be considered. We aimed to evaluate HACOR (heart rate, acidosis, consciousness, oxygenation, respiratory rate) score performance in these patients as predictor of CPAP failure. METHODS: Prospective observational multicentric study (three centers in different countries), including adult patients with SARS-CoV-2 pneumonia admitted to a respiratory intermediate care unit, presenting PaO2/FiO2 < 300 and PaCO2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated. RESULTS: We enrolled 128 patients, mean age 61,7 years. Mean HACOR at 1 h after starting CPAP was 3,27 ± 3,84 and mean PaO2/FiO2 was 203,30 ± 92,21 mmHg; 35 patients (27,3 %) presented CPAP failure: 29 underwent oro-tracheal intubation and 6 died due to COVID-19 (all having a do-not-intubate order). HACOR accuracy for predicting CPAP failure was 82,03 %, while PaO2/FiO2 accuracy was 81,25 %. CONCLUSION: Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO2/FiO2 has also shown to be a good predictor of failure.


Subject(s)
COVID-19/complications , COVID-19/therapy , Continuous Positive Airway Pressure , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , Acidosis , Aged , Blood Gas Analysis , COVID-19/physiopathology , Consciousness , Female , Heart Rate , Humans , Intubation, Intratracheal , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , ROC Curve , Respiratory Insufficiency/diagnosis , Respiratory Rate , Treatment Failure
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