vox index

VOX Index: Predicting HFNC Failure (One-Minute Journal Club)

This is a one-minute journal club.This is not medical advice. Read the full free article for yourself (link below).Hat tip to the authors.Link in my stories for the next 24 hours.How do you predict whether a patient on high-flow will need to be intubated?Eyeballing your patient is not quite good enough.The ROX index is a …

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high flow immunocompromised

High Flow Nasal Oxygen or NIV in the Immunocompromised?

There are numerous guidelines that have been published over the recent years regarding the use of high-flow nasal cannula. Those guidelines address different populations and can be found HERE. In addition, there are studies currently cooking to look at using high-flow in COPD patients. Colleagues are also looking into include high flow oxygen in the …

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high flow ards

High Flow Nasal Oxygen & The Berlin Definition of ARDS

High flow nasal cannula, aka nasal high flow, high flow oxygen, etc. is a technology that I have reviewed extensively before. It has numerous uses including pneumonia, asthma, heart failure, and even COPD. The ROX Index will also help us predict who will likely need to be intubated after failing high flow. That being said, …

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high flow copd

COPD & Nasal High Flow/High-Flow Nasal Cannula (NHF, HFNC, HFO)

Standard of care for patients who have acute COPD exacerbations with hypercapnia is to provide the patients with steroids, nebulizations, supplemental oxygen, and positive pressure. What if I were to tell you that one could potentially with the high flow nasal cannula systems to treat COPD exacerbations? Well, that's why you're here on this page. …

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intubation timing

Timing of Intubation in COVID-19 Patients: Early or Late?

The pendulum has swung when it comes to deciding when to proceed with intubation of our COVID-19 patients when it comes to timing. The early data suggested early intubation was the way to go as we were all terrified or aerosolization of the virus caused by the high-flow nasal oxygen or different modes of non-invasive …

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proning covid

Proning Spontaneously Breathing COVID-19 Patients

There have been many times during this pandemic where we have tried to reinvent the wheel when it comes to patient care. What we have learned, however, is that returning back to our evidence-based fundamentals have led to the best outcomes. The PROSEVA trial in 2013 showed us that prone positioning in ARDS patients led …

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high flow nasal cannula

High Flow Nasal Cannula in Clinical Practice: Recommendations/Guidelines

During this journey I have learned that standard-of-care is not necessarily practiced as well as we all think. We all have our own issues, but there are some things that should just be done in the interest of our patients. During the current pandemic, I have come to realize that many institutions did not have …

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Noninvasive Ventilation (NIV/BiPAP) in Acute Asthma Exacerbations

Believe it or not, there is not a lot of data regarding using noninvasive ventilation, also called NIV or BiPAP to care for patients with acute asthma exacerbations. The data is actually quite limited, unfortunately. This paper published a few days ago in the AJRCCM took a retrospective look at a large number of patients …

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high flow asthma

High Flow Nasal Cannula (HFNC) in Acute Severe Asthma Exacerbations

We all know what the standard of care is for adults who come in with acute asthma exacerbations. They receive supplemental oxygen to keep sats >92%, bronchodilators, anticholinergics, steroids, with possibly some bonus magnesium. In addition, we obtain a series of labs, chest films, and an arterial blood gas. The really sick patients have findings …

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ROX Index: Predicting Who Is or Isn’t Going to Fly on HFNC

We have all had this patient. Someone who is in acute hypoxemic respiratory failure, let's just call it pneumonia of some sort or ARDS, and the regular nasal cannula or a venti-mask can't cut it. They're not at the severity where you can eyeball the patient and just know that they need to be intubated. …

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