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No funding was received for the creation, development, and analysis of the data. CF and JV are funded by the Instituto de Salud Carlos III, Madrid, Spain (#CB06/06/1088; #PI16/00049; #PI18/01611; #PI19/00141). BLF and FA are supported by a Vanier Canada Graduate Scholarship from the Canadian Institute of Health Research.

Analysis of institutional authors

Munoz Morales, LauraAuthorLopez Varela, Elisa BlancaAuthorGonzalez Alvarez, RaquelAuthorReverter Segura, EnricAuthorGuasch Casany, EduardAuthorFerrer Monreal, MiquelAuthorPujol Sobrevia, Maria JesusAuthorBadia Jobal, Joan RamonAuthorCastro Revollo, PedroAuthorFernandez Gomez, JavierAuthorSoy Muner, DolorsAuthorNicolas Arfelis, Josep MAuthorMunoz Garcia, Jose EstebanAuthorPoch Lopez De Brinas, EstebanAuthorOrtiz Perez, Jose TomasAuthorPardo Munoz, MonicaAuthorNavarro Lopez, AlbaAuthorLopez Saiz, GemmaAuthorEsteban Corredera, DanielAuthorArias Guillen, MartaAuthorGarcía álvarez, AnaAuthorDiaz Sanchez, TaniaAuthorSolé Martí, CristinaAuthorTellez, AdriánAuthorAlonso, Josep RamonAuthorBragulat Baur, ErnestAuthorPerez Amill, LorenaAuthorGarcia Martinez, AnaAuthorYague Ribes, JordiAuthorMotos, AnnaAuthorMartinez Palli, GracielaAuthorBlanco Vich, IsabelAuthorAndrea Riba, RutAuthorZubizarreta Nafarrate, IratiAuthorSerra, AlbaAuthorPerez Medina, Jose IgnacioAuthorRodriguez Navaza, BarbaraAuthorSandoval Martínez, ElenaAuthorGarcia Lucio, JessicaAuthorPerez Mendez, LorenaAuthorEscudero Fernandez, Jose MiguelAuthorPerez Moreno, AlvaroAuthorMejia Rubiano, Juan CarlosAuthorBernat, MontseAuthorGarcia Santanach, CeciliaAuthorGil Gimeno, BalmaAuthorCastro Moran, NataliaAuthorGil Navarro, SilviaAuthorMellado-Artigas RCorresponding AuthorTorres AAuthorBarbeta EAuthorFerrando CAuthorCastella MAuthorRivas EAuthorSibila Vidal, OriolAuthor or co-author of article in journal with external admissions assessment committee
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Article

Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicenter observational study

Publicated to:Journal Of Intensive Care. 9 (1): 23- - 2021-03-05 9(1), DOI: 10.1186/s40560-021-00538-8

Authors: Mellado-Artigas, R; Ferrando, C; Mujica, LE; Ruiz, ML; Ferreyro, BL; Angriman, F; Arruti, E; Torres, A; Barbeta, E; Villar, J

Affiliations

Hosp Clin Barcelona, Inst Invest August Pi & Sunyer, Dept Anesthesiol & Crit Care, Villarroel 170, Barcelona 08025, Spain - Author
Hosp Clin Barcelona, Inst Invest August Pi & Sunyer, Dept Respirol, Barcelona, Spain - Author
Hosp Univ Dr Negrin, Res Unit, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Spain - Author
Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain - Author
St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada - Author
Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada - Author
Ubikare Technol, Vizcaya, Spain - Author
Univ Politecn Cataluna, Dept Math, Fac Engn, Barcelona, Spain - Author
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada - Author
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Abstract

We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation.This is a multicenter, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated.From a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.41-2.35], and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53; 95% CI: 0.37-0.72), and pH (OR 0.47; 95% CI: 0.24-0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95% CI 0.80-0.96).Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.

Keywords
cannulacovid-19hypoxemic respiratory failureinvasive mechanical ventilationAcute respiratory failureAdultAgedApacheArticleArtificial ventilationBlood analysisBlood carbon dioxide tensionBody temperatureBreathing rateCannulaChronic kidney failureChronic respiratory tract diseaseCohort analysisControlled studyCoronavirus disease 2019Covid-19Critically ill patientD dimerDiabetes mellitusDiagnostic test accuracy studyEndotracheal intubationFemaleGlasgow coma scaleHeart rateHigh flow nasal cannula therapyHigh-flow nasal oxygen therapyHorowitz indexHumanHypertensionHypoxemic respiratory failureIntensive care unitIntubationInvasive mechanical ventilationInvasive ventilationIschemic heart diseaseLength of stayLeukocyte countMajor clinical studyMaleMalignant neoplasmMean arterial pressureMulticenter studyObservational studyOxygen saturationPhPredictive valueProspective studyReceiver operating characteristicRespiratory tract parametersRisk factorRox indexSensitivity and specificitySequential organ failure assessment scoreSystolic blood pressureTreatment failure

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Intensive Care due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position 8/35, thus managing to position itself as a Q1 (Primer Cuartil), in the category Critical Care Medicine.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 2.35. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 17.65 (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-09, the following number of citations:

  • WoS: 37
  • Europe PMC: 32
  • OpenCitations: 37
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-09:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 142.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 142 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 15.15.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 9 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Canada.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Mellado Artigas, Ricard) and Last Author (Sibila Vidal, Oriol).

the author responsible for correspondence tasks has been Mellado Artigas, Ricard.