Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients.
Identifieur interne : 000D86 ( Main/Exploration ); précédent : 000D85; suivant : 000D87Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients.
Auteurs : Romain Jouffroy [France] ; Romain Kedzierewicz [France] ; Clement Derkenne [France] ; Kilian Bertho [France] ; Marine Scannavino [France] ; Benoit Frattini [France] ; Frederic Lemoine [France] ; Daniel Jost [France] ; Bertrand Prunet [France]Source :
- Journal of clinical medicine [ 2077-0383 ] ; 2020.
Abstract
BACKGROUND
There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting.
METHODS
We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI).
RESULTS
We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12-0.41,
CONCLUSION
An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results.
DOI: 10.3390/jcm9093025
PubMed: 32962227
Affiliations:
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sortKey="Bertho, Kilian" sort="Bertho, Kilian" uniqKey="Bertho K" first="Kilian" last="Bertho">Kilian Bertho</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Scannavino, Marine" sort="Scannavino, Marine" uniqKey="Scannavino M" first="Marine" last="Scannavino">Marine Scannavino</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules 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sort="Prunet, Bertrand" uniqKey="Prunet B" first="Bertrand" last="Prunet">Bertrand Prunet</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32962227</idno><idno type="pmid">32962227</idno><idno type="doi">10.3390/jcm9093025</idno><idno type="wicri:Area/Main/Corpus">000039</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000039</idno><idno type="wicri:Area/Main/Curation">000039</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000039</idno><idno type="wicri:Area/Main/Exploration">000039</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients.</title><author><name sortKey="Jouffroy, Romain" sort="Jouffroy, Romain" uniqKey="Jouffroy R" first="Romain" last="Jouffroy">Romain Jouffroy</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Kedzierewicz, Romain" sort="Kedzierewicz, Romain" uniqKey="Kedzierewicz R" first="Romain" last="Kedzierewicz">Romain Kedzierewicz</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Derkenne, Clement" sort="Derkenne, Clement" uniqKey="Derkenne C" first="Clement" last="Derkenne">Clement Derkenne</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Bertho, Kilian" sort="Bertho, Kilian" uniqKey="Bertho K" first="Kilian" last="Bertho">Kilian Bertho</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Scannavino, Marine" sort="Scannavino, Marine" uniqKey="Scannavino M" first="Marine" last="Scannavino">Marine Scannavino</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Frattini, Benoit" sort="Frattini, Benoit" uniqKey="Frattini B" first="Benoit" last="Frattini">Benoit Frattini</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Lemoine, Frederic" sort="Lemoine, Frederic" uniqKey="Lemoine F" first="Frederic" last="Lemoine">Frederic Lemoine</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Jost, Daniel" sort="Jost, Daniel" uniqKey="Jost D" first="Daniel" last="Jost">Daniel Jost</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Prunet, Bertrand" sort="Prunet, Bertrand" uniqKey="Prunet B" first="Bertrand" last="Prunet">Bertrand Prunet</name><affiliation wicri:level="3"><nlm:affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris</wicri:regionArea><placeName><region type="region" nuts="2">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j">Journal of clinical medicine</title><idno type="ISSN">2077-0383</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI).</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12-0.41, </p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results.</p></div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">32962227</PMID><DateRevised><Year>2020</Year><Month>09</Month><Day>24</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Print">2077-0383</ISSN><JournalIssue CitedMedium="Print"><Volume>9</Volume><Issue>9</Issue><PubDate><Year>2020</Year><Month>Sep</Month><Day>20</Day></PubDate></JournalIssue><Title>Journal of clinical medicine</Title><ISOAbbreviation>J Clin Med</ISOAbbreviation></Journal><ArticleTitle>Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">E3025</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.3390/jcm9093025</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI).</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12-0.41, <i>p</i> < 10<sup>-3</sup>) with a corresponding area under curve (AUC) of 0.91 (95% CI: 0.85-0.98). HI significantly differed between patients with and without prehospital intubation (1.0 ± 1.0 vs. 3.6 ± 1.8, respectively; <i>p</i> < 10<sup>-3</sup>). ROC curve analysis defined the optimal HI threshold as 1.3. Bivariate analysis revealed that HI <1.3 was significantly, positively associated with prehospital intubation (OR, 38.38; 95% CI: 11.57-146.54; <i>p</i> < 10<sup>-3</sup>). Multivariate logistic regression analysis demonstrated that prehospital intubation was significantly associated with HI (adjusted odds ratio (ORa), 0.20; 95% CI: 0.06-0.45; <i>p</i> < 10<sup>-3</sup>) and HI <3 (ORa, 51.08; 95% CI: 7.83-645.06; <i>p</i> < 10<sup>-3</sup>). After adjustment for confounders, the ORa between HI <1.3 and prehospital intubation was 3.6 (95% CI: 1.95-5.08; <i>p</i> < 10<sup>-3</sup>).</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Jouffroy</LastName><ForeName>Romain</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kedzierewicz</LastName><ForeName>Romain</ForeName><Initials>R</Initials><Identifier Source="ORCID">0000-0002-7081-075X</Identifier><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Derkenne</LastName><ForeName>Clement</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bertho</LastName><ForeName>Kilian</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Scannavino</LastName><ForeName>Marine</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Frattini</LastName><ForeName>Benoit</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lemoine</LastName><ForeName>Frederic</ForeName><Initials>F</Initials><Identifier Source="ORCID">0000-0003-0828-2818</Identifier><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jost</LastName><ForeName>Daniel</ForeName><Initials>D</Initials><Identifier Source="ORCID">0000-0002-6046-1234</Identifier><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Prunet</LastName><ForeName>Bertrand</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Paris Fire Brigade, Emergency Medicine Department, 1 Place Jules Renard, 75017 Paris, France.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>Switzerland</Country><MedlineTA>J Clin Med</MedlineTA><NlmUniqueID>101606588</NlmUniqueID><ISSNLinking>2077-0383</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">association</Keyword><Keyword MajorTopicYN="N">hypoxemia</Keyword><Keyword MajorTopicYN="N">index</Keyword><Keyword MajorTopicYN="N">intubation</Keyword><Keyword MajorTopicYN="N">prehospital</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>07</Month><Day>25</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2020</Year><Month>09</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>09</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>23</Day><Hour>1</Hour><Minute>3</Minute></PubMedPubDate><PubMedPubDate 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sort="Derkenne, Clement" uniqKey="Derkenne C" first="Clement" last="Derkenne">Clement Derkenne</name><name sortKey="Frattini, Benoit" sort="Frattini, Benoit" uniqKey="Frattini B" first="Benoit" last="Frattini">Benoit Frattini</name><name sortKey="Jost, Daniel" sort="Jost, Daniel" uniqKey="Jost D" first="Daniel" last="Jost">Daniel Jost</name><name sortKey="Kedzierewicz, Romain" sort="Kedzierewicz, Romain" uniqKey="Kedzierewicz R" first="Romain" last="Kedzierewicz">Romain Kedzierewicz</name><name sortKey="Lemoine, Frederic" sort="Lemoine, Frederic" uniqKey="Lemoine F" first="Frederic" last="Lemoine">Frederic Lemoine</name><name sortKey="Prunet, Bertrand" sort="Prunet, Bertrand" uniqKey="Prunet B" first="Bertrand" last="Prunet">Bertrand Prunet</name><name sortKey="Scannavino, Marine" sort="Scannavino, Marine" uniqKey="Scannavino M" first="Marine" last="Scannavino">Marine Scannavino</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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