{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T23:25:57Z","timestamp":1773876357431,"version":"3.50.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T00:00:00Z","timestamp":1682035200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T00:00:00Z","timestamp":1682035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>In the current context of the SARS COVID-19 pandemic, where the main cause of death is respiratory failure, and since early recognition would allow timely measures to be implemented and probably improve outcomes, it is important to have tools that allow the emergency room to predict quickly and without the use of large resources which will need invasive mechanical ventilation. This study proposes using a new predictive index of noninvasive characteristics, based on the relationship between oxygenation and work of breathing measured by ultrasound-assessed diaphragmatic function, for the need for invasive mechanical ventilation in patients with SARS-COV2 infection who are admitted to the emergency department.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A prospective predictive cohort study was performed, collecting all patients admitted to the emergency room with respiratory failure (not severe or in imminent respiratory arrest) and a confirmed diagnosis of SARS-CoV-2 pneumonia. Diaphragmatic excursion measurements were taken within the first 24\u00a0h after admission to the department. The relationship between diaphragmatic excursion and SAFI was calculated, establishing the ultrasound diaphragmatic excursion So2\/FiO2 index (U.D.E.S.I). The index\u2019s performance was determined by analysis of sensitivity, specificity, and area under the curve (AUC).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>This pilot study analyzed the first 100 patients enrolled and found in-hospital mortality of 19%, all patients who died required mechanical ventilation, the right index showed a specificity of 82.4% with a sensitivity of 76.9%, likewise for the left index an overall specificity of 90.5% with a sensitivity of 65.3% was found. The ideal cut-off point for the right index is 1.485, and for the left index, the threshold point was 1.856. AUC of the right index is 0.798 (0.676\u20130.920) and of the left index 0.793 (0.674\u20130.911), when comparing them no significant differences were found between these values <jats:italic>p<\/jats:italic>\u2009=\u20090.871.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The relationship of So2\/FiO2 and diaphragm excursion measured by both right and left ultrasound could predict the need for mechanical ventilation of the patient with COVID-19 pneumonia in the emergency room and could constitute a valuable tool since it uses noninvasive parameters and is easily applicable at the patient\u2019s bedside. However, a more extensive study is needed to validate these preliminary results.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12890-023-02435-2","type":"journal-article","created":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T06:02:48Z","timestamp":1682056968000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A new non-invasive index for the prediction of endotracheal intubation in patients with SARS COVID-19 infection, in the emergency department, pilot study"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2688-3086","authenticated-orcid":false,"given":"Germ\u00e1n Devia","family":"Jaramillo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Carlos Venegas","family":"Sanabria","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Buitrago","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,21]]},"reference":[{"issue":"3","key":"2435_CR1","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/s0025-7125(16)31188-9","volume":"67","author":"R Balk","year":"1983","unstructured":"Balk R, Bone RC. Classification of acute respiratory failure. Med Clin North Am. 1983;67(3):551\u20136. https:\/\/doi.org\/10.1016\/s0025-7125(16)31188-9.","journal-title":"Med Clin North Am."},{"issue":"3","key":"2435_CR2","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/s0031-3955(16)33753-1","volume":"26","author":"CJ Newth","year":"1979","unstructured":"Newth CJ. Recognition and management of respiratory failure. Pediatr Clin North Am. 1979;26(3):617\u201343. https:\/\/doi.org\/10.1016\/s0031-3955(16)33753-1.","journal-title":"Pediatr Clin North Am."},{"issue":"2","key":"2435_CR3","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s15010-020-01531-3","volume":"49","author":"B Salzberger","year":"2021","unstructured":"Salzberger B, Buder F, Lampl B, et al. Epidemiology of SARS-CoV-2. Infection. 2021;49(2):233\u20139. https:\/\/doi.org\/10.1007\/s15010-020-01531-3.","journal-title":"Infection."},{"issue":"9","key":"2435_CR4","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1056\/NEJMra1208623","volume":"369","author":"DC Angus","year":"2013","unstructured":"Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840\u201351. https:\/\/doi.org\/10.1056\/NEJMra1208623.","journal-title":"N Engl J Med."},{"key":"2435_CR5","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.jcrc.2016.05.022","volume":"35","author":"O Roca","year":"2016","unstructured":"Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016;35:200\u20135. https:\/\/doi.org\/10.1016\/j.jcrc.2016.05.022.","journal-title":"J Crit Care."},{"issue":"23","key":"2435_CR6","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.1001\/jama.2012.5669","volume":"307","author":"VM Ranieri","year":"2012","unstructured":"ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526\u201333. https:\/\/doi.org\/10.1001\/jama.2012.5669.","journal-title":"JAMA."},{"key":"2435_CR7","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.ajem.2021.01.092","volume":"44","author":"P Catoire","year":"2021","unstructured":"Catoire P, Tellier E, de la Rivi\u00e8re C, et al. Assessment of the SpO2\/FiO2 ratio as a tool for hypoxemia screening in the emergency department. Am J Emerg Med. 2021;44:116\u201320. https:\/\/doi.org\/10.1016\/j.ajem.2021.01.092.","journal-title":"Am J Emerg Med."},{"issue":"5","key":"2435_CR8","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1159\/000446518","volume":"91","author":"GF Sferrazza Papa","year":"2016","unstructured":"Sferrazza Papa GF, Pellegrino GM, Di Marco F, et al. A Review of the Ultrasound Assessment of Diaphragmatic Function in Clinical Practice. Respiration. 2016;91(5):403\u201311. https:\/\/doi.org\/10.1159\/000446518.","journal-title":"Respiration."},{"issue":"4","key":"2435_CR9","doi-asserted-by":"publisher","first-page":"542","DOI":"10.4187\/respcare.04412","volume":"61","author":"M Umbrello","year":"2016","unstructured":"Umbrello M, Formenti P. Ultrasonographic Assessment of Diaphragm Function in Critically Ill Subjects. Respir Care. 2016;61(4):542\u201355. https:\/\/doi.org\/10.4187\/respcare.04412.","journal-title":"Respir Care."},{"issue":"1","key":"2435_CR10","doi-asserted-by":"publisher","first-page":"98","DOI":"10.2991\/jegh.k.200928.001","volume":"11","author":"A Alharthy","year":"2021","unstructured":"Alharthy A, Aletreby W, Faqihi F, et al. Clinical Characteristics and Predictors of 28-Day Mortality in 352 Critically Ill Patients with COVID-19: A Retrospective Study. J Epidemiol Glob Health. 2021;11(1):98\u2013104. https:\/\/doi.org\/10.2991\/jegh.k.200928.001.","journal-title":"J Epidemiol Glob Health."},{"issue":"2","key":"2435_CR11","doi-asserted-by":"publisher","first-page":"105","DOI":"10.24920\/003724","volume":"35","author":"MZ Zuo","year":"2020","unstructured":"Zuo MZ, Huang YG, Ma WH, et al. Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019. Chin Med Sci J. 2020;35(2):105\u20139. https:\/\/doi.org\/10.24920\/003724.","journal-title":"Chin Med Sci J."},{"issue":"1","key":"2435_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5603\/ARM.a2020.0176","volume":"89","author":"LA Suliman","year":"2021","unstructured":"Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Adv Respir Med. 2021;89(1):1\u20137. https:\/\/doi.org\/10.5603\/ARM.a2020.0176.","journal-title":"Adv Respir Med."},{"issue":"8","key":"2435_CR13","doi-asserted-by":"publisher","first-page":"3361","DOI":"10.1111\/jan.14848","volume":"77","author":"A Zaboli","year":"2021","unstructured":"Zaboli A, Ausserhofer D, Pfeifer N, et al. The ROX index can be a useful tool for the triage evaluation of COVID-19 patients with dyspnoea. J Adv Nurs. 2021;77(8):3361\u20139. https:\/\/doi.org\/10.1111\/jan.14848.","journal-title":"J Adv Nurs."},{"issue":"6","key":"2435_CR14","doi-asserted-by":"publisher","first-page":"909","DOI":"10.4187\/respcare.08631","volume":"66","author":"A Chandel","year":"2021","unstructured":"Chandel A, Patolia S, Brown AW, et al. High-Flow Nasal Cannula Therapy in COVID-19: Using the ROX Index to Predict Success. Respir Care. 2021;66(6):909\u201319. https:\/\/doi.org\/10.4187\/respcare.08631.","journal-title":"Respir Care."},{"key":"2435_CR15","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.ajem.2021.07.049","volume":"50","author":"A Mukhtar","year":"2021","unstructured":"Mukhtar A, Rady A, Hasanin A, et al. Admission SpO2 and ROX index predict outcome in patients with COVID-19. Am J Emerg Med. 2021;50:106\u201310. https:\/\/doi.org\/10.1016\/j.ajem.2021.07.049.","journal-title":"Am J Emerg Med."},{"issue":"6","key":"2435_CR16","doi-asserted-by":"publisher","first-page":"100976","DOI":"10.1016\/j.accpm.2021.100976","volume":"40","author":"M Adolf Helmy","year":"2021","unstructured":"Adolf Helmy M, Magdy Milad L, Hasanin A, Mostafa M. The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019. Anaesthesia Critical Care & Pain Medicine. 2021;40(6):100976. https:\/\/doi.org\/10.1016\/j.accpm.2021.100976.","journal-title":"Anaesthesia Critical Care & Pain Medicine."},{"issue":"21","key":"2435_CR17","doi-asserted-by":"publisher","first-page":"00092","DOI":"10.1016\/j.pulmoe.2021.04.003","volume":"S2531\u20130437","author":"ML Vega","year":"2021","unstructured":"Vega ML, Dongilli R, Olaizola G, et al. COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU. Pulmonology. 2021;S2531\u20130437(21):00092\u20131. https:\/\/doi.org\/10.1016\/j.pulmoe.2021.04.003.","journal-title":"Pulmonology."}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-023-02435-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-023-02435-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-023-02435-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,21]],"date-time":"2023-04-21T06:04:09Z","timestamp":1682057049000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-023-02435-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,21]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["2435"],"URL":"https:\/\/doi.org\/10.1186\/s12890-023-02435-2","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,21]]},"assertion":[{"value":"19 July 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study has received ethics approval from research ethics committee of the Universidad del Rosario, life sciences room. Reference number 466 CEI-UR, DVO005 1814-CV1511.This research is classified within the category \u201cno risk\u201d. Access to research instruments was limited only to investigators according to Article 8 of Resolution 008430\/1993 by the Colombian Ministry of Health.All patients admitted to emergency department signed a generic form (patient consent F-CME-22\u00a0V.0). They accepted and gave their written informed consent for the use and publication of their medical records for academic and research purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publications"}},{"value":"The authors disclose no competing of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"135"}}