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Research ArticleOriginal Research

Prediction of Extubation Failure in COVID-19

Pedro H de Andrade Filho, Eduardo S de Assis Brasil, Ladyer G Costa, Daniel Escóssia M Sousa, Talison S Pereira and João Manoel Silva
Respiratory Care August 2021, 66 (8) 1323-1329; DOI: https://doi.org/10.4187/respcare.08564
Pedro H de Andrade Filho
Anesthesiology Department, São Paulo- Hospital do Servidor Publico Estadual, São Paulo, Brazil.
Postgraduate Program in Anesthesiology, Surgical Sciences, and Perioperative Medicine, Faculdade de Medicina da Universidade de São Paulo-FMUSP, São Paulo, Brazil.
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Eduardo S de Assis Brasil
Anesthesiology Department, São Paulo- Hospital do Servidor Publico Estadual, São Paulo, Brazil.
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Ladyer G Costa
Anesthesiology Department, São Paulo- Hospital do Servidor Publico Estadual, São Paulo, Brazil.
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Daniel Escóssia M Sousa
Anesthesiology Department, São Paulo- Hospital do Servidor Publico Estadual, São Paulo, Brazil.
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Talison S Pereira
Anesthesiology Department, São Paulo- Hospital do Servidor Publico Estadual, São Paulo, Brazil.
Postgraduate Program in Anesthesiology, Surgical Sciences, and Perioperative Medicine, Faculdade de Medicina da Universidade de São Paulo-FMUSP, São Paulo, Brazil.
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João Manoel Silva Jr
Anesthesiology Department, São Paulo- Hospital do Servidor Publico Estadual, São Paulo, Brazil.
Postgraduate Program in Anesthesiology, Surgical Sciences, and Perioperative Medicine, Faculdade de Medicina da Universidade de São Paulo-FMUSP, São Paulo, Brazil.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Embedded Image may be a reliable noninvasive alternative to the Embedded Image index. Furthermore, the ROX index (ie, the ratio of Embedded Image to breathing frequency) has been validated to predict high-flow nasal cannula failure in subjects under spontaneous breathing. However, these indices have not been tested in subjects with COVID-19 receiving invasive mechanical ventilation. This study aims to verify the correlation between both the ROX index and Embedded Image with Embedded Image and the ratio of Embedded Image to breathing frequency, and to determine the accuracy of the indices that use Embedded Image for the prediction of extubation failure in subjects with COVID-19.

METHODS: A prospective cohort study was conducted from May 15, 2020, to June 15, 2020, with subjects with COVID-19 on invasive mechanical ventilation. Indices using Embedded Image in the formula were compared to those using Embedded Image. Additionally, the performance of the indices in predicting extubation failure was evaluated.

RESULTS: This study included 69 subjects age 64.8 ± 14.6 y. There were no differences between the median values of the indices, including between the ROX index and Embedded Image to breathing frequency (P = .40) or between Embedded Image and Embedded Image (P = .83). When comparing the ROX index with the Embedded Image index to breathing frequency, they were found to be strongly correlated (R2 = 0.75 [95% CI 0.6763–0.8152], P < .001). The comparison of Embedded Image with Embedded Image revealed R2 = 0.70 (95% CI 0.563–0.749, P < .001). The area under the receiver operating characteristic curve for the ROX index to determine extubation failure was 0.74 (P = .01), whereas for Embedded Image it was 0.78 (P < .001).

CONCLUSIONS: The indices presented a good correlation in subjects with COVID-19 on invasive mechanical ventilation, and both the ROX index and Embedded Image can discriminate extubation failure in this population.

  • COVID-19
  • mechanical ventilation
  • pulse oximeter
  • critical care
  • respiratory failure
  • extubation failure

Footnotes

  • Correspondence: João Manoel Silva Jr MD PhD, Anesthesiology Division, Central Institute, University of São Paulo, Faculty of Medicine Clinics Hospital, 05403–000 São Paulo, Brazil. E-mail: joao.s{at}usp.br
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (8)
Respiratory Care
Vol. 66, Issue 8
1 Aug 2021
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Prediction of Extubation Failure in COVID-19
Pedro H de Andrade Filho, Eduardo S de Assis Brasil, Ladyer G Costa, Daniel Escóssia M Sousa, Talison S Pereira, João Manoel Silva
Respiratory Care Aug 2021, 66 (8) 1323-1329; DOI: 10.4187/respcare.08564

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Prediction of Extubation Failure in COVID-19
Pedro H de Andrade Filho, Eduardo S de Assis Brasil, Ladyer G Costa, Daniel Escóssia M Sousa, Talison S Pereira, João Manoel Silva
Respiratory Care Aug 2021, 66 (8) 1323-1329; DOI: 10.4187/respcare.08564
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Keywords

  • COVID-19
  • mechanical ventilation
  • pulse oximeter
  • critical care
  • respiratory failure
  • extubation failure

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