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Caravaca Perez, PedroAuthor

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January 8, 2025
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High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19

Publicated to:Multidisciplinary Respiratory Medicine. 15 (1): 693- - 2020-01-01 15(1), DOI: 10.4081/mrm.2020.693

Authors: Panadero, Carolina; Abad-Fernandez, Araceli; Teresa Rio-Ramirez, Ma; Acosta Gutierrez, Carmen Maria; Calderon-Alcala, Mariara; Lopez-Riolobos, Cristina; Matesanz-Lopez, Cristina; Garcia-Prieto, Fernando; Maria Diaz-Garcia, Jose; Raboso-Moreno, Beatriz; Vasquez-Gambasica, Zully; Andres-Ruzafa, Pilar; Luis Garcia-Satue, Jose; Calero-Pardo, Sara; Sagastizabal, Belen; Bautista, Diego; Campos, Alfonso; Gonzalez, Marina; Grande, Luis; Jimenez Fernandez, Marta; Santiago-Ruiz, Jose L; Caravaca Perez, Pedro; Jose Alcaraz, Andres

Affiliations

Hosp Univ 12 Octubre, Inst Invest Sanitaria Hosp 12 Octubre Imas12, Cardiol Dept, CIBERCV, Madrid, Spain - Author
Hosp Univ Getafe, Cardiol Dept, Madrid, Spain - Author
Hosp Univ Getafe, Dept Pediat, Madrid, Spain - Author
Hosp Univ Getafe, Pulmonol Dept, Carr Madrid Toledo Km 12-500, Madrid 28905, Spain - Author
Hosp Univ Getafe, Thorac Surg Dept, Madrid, Spain - Author
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Abstract

Introduction: High-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2. Methods: A retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation. Results: In the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO(2)/FiO(2) ratio was significantly better in the group that did not require intubation (113.4 +/- 6.6 vs 93.7 +/- 6.7, p=0.020), as was the ROX index (5.0 +/- 1.6 vs 4.0 +/- 1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 - 13.7]; p=0.026). Conclusion: High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.

Keywords

Acute respiratory distress syndromeCoronaviruCoronavirusCovid-19FailurHigh-flow nasal cannulaOxygen-therapyPneumonia

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Multidisciplinary Respiratory Medicine due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position , thus managing to position itself as a Q2 (Segundo Cuartil), in the category Pulmonary and Respiratory Medicine.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 24.88, which 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: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-04, the following number of citations:

  • WoS: 68
  • Europe PMC: 52

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 2025-08-04:

  • 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: 165.
  • 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: 174 (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: 0.75.
  • The number of mentions on the social network X (formerly Twitter): 2 (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.