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Observational Study
. 2021 Nov-Dec:189:106638.
doi: 10.1016/j.rmed.2021.106638. Epub 2021 Oct 6.

ROX index as predictor of high flow nasal cannula therapy success in acute respiratory failure due to SARS-CoV-2

Santos Ferrer  1 , Jesús Sancho  2 , Irene Bocigas  1 , Enric Bures  1 , Heidi Mora  1 , Erik Monclou  1 , Alba Mulet  1 , Antonio Quezada  1 , Pablo Royo  1 , Jaime Signes-Costa  1
Affiliations
Observational Study

ROX index as predictor of high flow nasal cannula therapy success in acute respiratory failure due to SARS-CoV-2

Santos Ferrer et al. Respir Med. 2021 Nov-Dec.

Abstract

Background: High-Flow Nasal Cannula (HFNC) therapy is useful treatment in patients with acute respiratory failure (ARF). The ROX index (ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate) has been evaluated to predict success of HFNC in patients with pneumonia.

Objective: The aim of this study was to determine whether the ROX Index could predict HFNC therapy success in patients with ARF due to SARS-CoV-2 pneumonia.

Methods: An observational, prospective study was performed including patients admitted with ARF secondary to SARS-CoV-2 pneumonia who met criteria for HFNC therapy initiation. Demographic, radiological, laboratory and clinical course data were collected. The ROX index was calculated at 1 h, 6 h, 12 h and 24 h after starting HFNC.

Results: In total 85 patients were included (age, 64.51 + 11.78 years; male, 69.4%). HFNC failed in 47 (55.3%) patients, of whom 45 (97.8%) were initially managed with noninvasive ventilation (NIV). ROX index at 24 h was the best predictor of HFNC success (AUC 0.826, 95%CI 0.593-1.00, p = 0.015) with a cut-off point of 5.35 (S 0.91, Sp 0.79, PPV 0.92, NPP 0.79). In multivariate logistic regression analysis ROX index at 24 h proved the best predictor of HFNC success.

Conclusions: ROX index at 24 h with a cut-off point of 5.35 predicts HFNC success in patients with SARS-Cov-2-induced ARF.

Keywords: COVID-19; High flow nasal cannula; Mechanical ventilation; Respiratory failure.

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Conflict of interest statement

All the authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flowchart.
Fig. 2
Fig. 2
Accumulated probability of HFNC success according to ROX index at A = 1 h, B = 6 h, C = 12 h, D = 24 hours
See this image and copyright information in PMC

References

    1. World Health Organization Coronavirus disease (COVID-19) outbreak. Disposable at. https://www.who.int
    1. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X., et al. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020 Apr 30;382(18):1708–1720. doi: 10.1056/NEJMoa2002032. Epub 2020 Feb 28. PMID: 32109013; PMCID: PMC7092819. - DOI - PMC - PubMed
    1. Scala R., Heunks L. Highlights in acute respiratory failure. Eur. Respir. Rev. 2018;27:180008. - PMC - PubMed
    1. Uyeki T.M., Bernstein H.H., Bradley J.S., Englund J.A., File T.M., Fry A.M., et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 Update on diagnosis, treatment chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin. Infect. Dis. 2019;68:e1–47. - PMC - PubMed
    1. Rochwerg B., Brochard L., Elliott M.W., et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur. Respir. J. 2017;50:1602426. doi: 10.1183/13993003.02426-2016. - DOI - PubMed

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