Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children

Yıldızdaş, Dinçer; Yöntem, Ahmet; Iplik, Gokce; Horoz, Özden Özgür; Ekinci, Faruk

doi:10.1007/s00431-020-03847-6

Cited by 36 publications

(38 citation statements)

References 19 publications

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“…The authors found that a higher ROX index score was associated with HFNC success at all time points analyzed, and they concluded that a ROX index value of ≥ 4.88 at 12 h after the initiation of HFNC therapy was significantly associated with HFNC success. However, in children, predicting success using the ROX index can be much more difficult, because the respiratory rate can vary with age (27). In our study, there were no significant differences in initial and lowest ROX index scores between the two groups.…”

Section: The Risk Factors For Escalation Of Therapy With the Use Of Hfnc Therapycontrasting

confidence: 56%

High-Flow Nasal Cannula Therapy in Children With Acute Respiratory Distress With Hypoxia in A Pediatric Intensive Care Unit–A Single Center Experience

et al. 2021

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Aim: High-flow nasal cannulas (HFNCs) show potential in the application of positive pressure, improving gas exchange, and decreasing work of breathing in patients with acute respiratory distress. The aims of this study were to elucidate the indications for HFNC therapy in children of all ages and diagnoses, and to evaluate the efficacy and risk factors for failure of HFNC therapy in children with acute respiratory distress with hypoxia in a pediatric intensive care unit.Methods: We conducted this retrospective cohort study at a tertiary pediatric intensive care unit between January 1, 2018 and December 31, 2020. All children, from 1 month to 18 years of age, with acute respiratory distress with hypoxia and HFNC therapy were eligible. The clinical data were reviewed.Results: One hundred and two children met the eligibility criteria for the study, of whom 57 (55.9%) were male, and the mean age was 7.00 ± 6.79 years. Seventy-eight (76.5%) of the children had underlying disorders. The most common indications for the use of HFNC therapy were pneumonia (40, 39.2%), sepsis-related respiratory distress (17, 16.7%), and bronchiolitis (16, 15.7%). The failure rate was 15.7% (16 of 102 children). Higher initial and maximum fraction of inspiration O2 levels and lower initial and lowest SpO2/FiO2 (S/F) ratio were early and possible signs of failure requiring escalation of respiratory support.Conclusion: In our population, we found that HFNC therapy could be initiated as the first-line therapy for various etiologies of acute respiratory distress with hypoxia in a pediatric intensive care unit and for all age groups.

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Section: The Risk Factors For Escalation Of Therapy With the Use Of Hfnc Therapycontrasting

confidence: 56%

High-Flow Nasal Cannula Therapy in Children With Acute Respiratory Distress With Hypoxia in A Pediatric Intensive Care Unit–A Single Center Experience

et al. 2021

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“…No se encontraron diferencias en la tasa de IOT y la mortalidad entre la CNAF y la oxigenoterapia estándar o CPAP. Estos resultados ayudan a mantener abierta la controversia acerca de las incertidumbres que aun rodean las indicaciones, grupos de edad, comorbilidades y gravedad de la dificultad respiratoria que debe ser considerada al seleccionar los pacientes candidatos a oxigenoterapia con CNAF fuera del ámbito de UCIP (22)(23)(24).…”

Section: Resultsunclassified

Oxigenoterapia Con Cánula Nasal De Alto Flujo: Experiencia en Un Servicio De Urgencias De La Ciudad De Bogotá

D.¹,

et al. 2022

Neumol Pediatr

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El objetivo de este estudio es analizar desenlaces clínicos de oxigenoterapia con cánula nasal de alto flujo (CNAF) en niños con dificultad respiratoria aguda en un servicio de urgencias. Estudio longitudinal, retrospectivo de datos panel en niños con diagnóstico de dificultad respiratoria moderada- severa. El resultado primario de interés fue ingreso a unidad de cuidados intensivos pediátricos (UCIP) o requerir intubación 24 horas posteriores al inicio de la terapia. Se calcularon medidas de frecuencia y tendencia central. Los grupos se compararon con las pruebas Chi2, Fisher, Wilcoxon y Kruskal-Wallis. El análisis de datos panel balanceados identificó puntos de inflexión en las curvas de normalización de respuesta respiratoria. Un total de 339 niños de 0 a 16 años cumplieron los criterios de inclusión. Mayoría hombres (62,24%), mediana de edad 2 años (RIQ= 0,75-3) y neumonía como principal causa de dificultad respiratoria (33,92%). El ingreso a UCIP (14,5%) y la intubación (0,9%) fue baja en la cohorte. En las primeras tres horas con CNAF se evidenció mejoría en los parámetros respiratorios, sin diferencias significativas entre pacientes con y sin respuesta clínica (frecuencia cardiaca p=0,317; frecuencia respiratoria p=0,423; SatO2 p=0,297; FiO2 p=0,116). No se presentaron eventos adversos ni casos de mortalidad. Los resultados sugieren que la oxigenoterapia con CNAF puede ser una alternativa de soporte respiratorio inicial en niños *16 años con dificultad respiratoria moderada a severa. La incidencia de intubación e ingreso a UCIP fue baja. La CNAF fue bien tolerada en los diferentes grupos de edad.

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“…ROX index, defined as the ratio of SpO 2 /FiO 2 to respiratory rate, has been reported to have a high predictive value to identify HFNC failure in critically ill patients with acute hypoxemic respiratory failure (AHRF) ( 35 ). A study published 2 years later discovered that combining pediatric ROX index (p-ROXI) and its dynamic alterations can successfully predict HFNC failure within 24 h and 48 h of therapy onset ( 36 ). However, the respiratory rate z-score, instead of respiratory rate, is not routinely used clinically and is cumbersome and decreased the value as a bedside monitoring indicator.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study

Liu

Li²,

Liu³

et al. 2022

Front. Pediatr.

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BackgroundEvidence-based clinical practice guidelines regarding high-flow nasal cannula (HFNC) use for respiratory support in critically ill children are lacking. Therefore, we aimed to determine the risk factors for early HFNC failure to reduce the failure rate and prevent adverse consequences of HFNC failure in children with acute respiratory dysfunction.MethodsDemographic and laboratory data were compared among patients, admitted to the pediatric intensive care unit between January 2017 and December 2018, who were included in a retrospective cohort study. Univariate and multivariate analyses were performed to determine risk factors for eventual entry into the predictive model for early HFNC failure and to perform an external validation study in a prospective observational cohort study from January to February 2019. Further, the association of clinical indices and trends pre- and post-treatment with HFNC treatment success or failure in these patients was dynamically observed.ResultsIn total, 348 pediatric patients were included, of these 282 (81.0%) were included in the retrospective cohort study; HFNC success was observed in 182 patients (64.5%), HFNC 0–24 h failure in 74 patients (26.2%), and HFNC 24–48 h failure in 26 patients (9.2%). HFNC 24 h failure was significantly associated with the pediatric risk of mortality (PRISM) III score [odds ratio, 1.391; 95% confidence interval (CI): 1.249–1.550], arterial partial pressure of carbon dioxide-to-arterial partial pressure of oxygen (PaCO2/PaO2) ratio (odds ratio, 38.397; 95% CI: 6.410–230.013), and respiratory rate-oxygenation (ROX) index (odds ratio, 0.751; 95% CI: 0.616–0.915). The discriminating cutoff point for the new scoring system based on the three risk factors for HFNC 24 h failure was ≥ 2.0 points, with an area under the receiver operating characteristic curve of 0.794 (95% CI, 0.729–0.859, P < 0.001), sensitivity of 68%, and specificity of 79%; similar values were noted on applying the model to the prospective observational cohort comprising 66 patients (AUC = 0.717, 95% CI, 0.675–0.758, sensitivity 83%, specificity 44%, P = 0.009). In this prospective cohort, 11 patients with HFNC failure had an upward trend in PaCO2/PaO2 ratio and downward trends in respiratory failure index (P/F ratio) and ROX index; however, opposite directions of change were observed in 55 patients with HFNC success. Furthermore, the fractional changes (FCs) in PaCO2/PaO2 ratio, P/F ratio, percutaneous oxygen saturation-to-fraction of inspired oxygen (S/F) ratio, and ROX index at 2 h post-HFNC therapy onset were statistically significant between the two groups (all, P < 0.05).ConclusionIn the pediatric patients with acute respiratory insufficiency, pre-treatment PRISM III score, PaCO2/PaO2 ratio, and ROX index were risk factors for HFNC 24 h failure, and the direction and magnitude of changes in the PaCO2/PaO2 ratio, P/F ratio, and ROX index before and 2 h after HFNC treatment were warning indicators for HFNC 24 h failure. Further close monitoring should be considered for patients with these conditions.

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Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children

Cited by 36 publications

References 19 publications

High-Flow Nasal Cannula Therapy in Children With Acute Respiratory Distress With Hypoxia in A Pediatric Intensive Care Unit–A Single Center Experience

High-Flow Nasal Cannula Therapy in Children With Acute Respiratory Distress With Hypoxia in A Pediatric Intensive Care Unit–A Single Center Experience

Oxigenoterapia Con Cánula Nasal De Alto Flujo: Experiencia en Un Servicio De Urgencias De La Ciudad De Bogotá

Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case–control study

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