An Integrated Model including the ROX Index to Predict the Success of High-Flow Nasal Cannula Use after Planned Extubation: A Retrospective Observational Cohort Study

Abstract

High-flow nasal cannula (HFNC) therapy is commonly used to prevent reintubation after planned extubation. In clinical practice, there are no appropriate tools to evaluate whether HFNC therapy was successful or failed after planned extubation. In this retrospective observational study, we investigated whether the use of the ROX index was appropriate to differentiate between HFNC success and failure within 72 h after extubation and to develop an integrated model including the ROX index to improve the prediction of HFNC success in patients receiving HFNC therapy after planned extubation. Of 276 patients, 50 patients (18.1%) were reintubated within 72 h of extubation. ROX index values of >8.7 at 2 h, >8.7 at 6 h, and >10.4 at 12 h after HFNC therapy were all meaningful predictors of HFNC success in extubated patients. In addition, the integrated model including the ROX index had a better predictive capability for HFNC success than the ROX index alone. In conclusion, the ROX index at 2, 6, and 12 h could be applied to extubated patients to predict HFNC success after planned extubation. To improve its predictive power, we should also consider an integrated model consisting of the ROX index, sex, body mass index, and the total duration of ventilator care.

Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure

“…In-hospital mortality was 5% (10 patients) and its main cause was the progression of the triggering cause of ARF. In these patients, the ROX index showed a significant deterioration at 120 min and 24 h, a value that coincides with that obtained by Lee et al 48 at 2 and 6 h after initiation of HFNC, immediately before extubation in an ICU. We believe that the use of the ROX index is fundamental when monitoring patients treated with HFNC 49 as has been confirmed in the current pandemic situation due to SARS CoV-2 infection.…”

The Respiratory Rate-Oxygenation Index predicts failure of post-extubation high-flow nasal cannula therapy in intensive care unit patients: a retrospective cohort study

“…Additionally, they described an AUC of 0.72 (0.66 - 0.78) for predicting the success of HFNC. ( 23 ) Literature on this particular scenario is scarce, and our results agreed with the utility of the ROX index in the post-extubation period, favoring a narrower cutoff point of 4.88, unlike other authors who were laxer with their indices.…”

“…The mortality rate associated with extubation failure is between 30 and 40%, ( 24 ) and consequently, patients who fail HFNC after invasive mechanical ventilation removal present significantly higher mortality events than patients who tolerate HFNC treatment. ( 23 , 25 ) To improve survival, a predictor is necessary that allows early decisions and does not delay reintubation in patients who fail HFNC. ( 22 , 26 ) The ROX index has also been studied for mortality prediction in patients with AHRF at the emergency department or the intermediary care unit.…”

Cardiac Dysfunction Is Not Associated with Increased Reintubation Rate in Patients Treated with Post-extubation High-Flow Nasal Cannula

“…Third, respiratory mechanics such as rapid shallow breathing index or maximal inspiratory pressure were not compared or included in the analysis though they were well-known weaning predictors. However, SBT was performed according to the institutional protocol in which tidal volume and respiratory are included [ 17 ], we believe that respiratory rate, tidal volume, and eventually rapid shallow breathing index would be in adequate range in both groups. In addition, this study was conducted retrospectively at a single institution in a small number of medical ICU patients.…”

“…After planned extubation, HFNC (Airvo 2, Fisher and Paykel Healthcare, Laval, QC, Canada) was initiated at a flow rate of 50 L/min with fraction of inspired oxygen (FiO 2 ) of 0.5. Detailed protocol of weaning and post-extubation practice was reported in elsewhere [ 17 ].…”