Predicting Outcomes of High-Flow Nasal Cannula for Acute Respiratory Distress Syndrome. An Index that ROX

Hill, Nicholas S.; Ruthazer, Robin

doi:10.1164/rccm.201901-0079ed

Cited by 25 publications

(23 citation statements)

References 11 publications

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“…Roca and colleagues [6,7] first published an index ROX which can predict whether the patient will fail to use high frequency nasal canula (HFNC) in pneumonia in ICU, and they reported that a ROX value of > 4.88 predicted the success of HFNC. Also, in Nicholas and Robin's study [8], the ROX index was validated in 191 critically ill patients enrolled at 5 centers in France and Spain, and the ROX index score of 4.88 was used as predictive of outcomes. The area under the curve at 12 hours of HFNC use was 0.752.…”

Section: Discussionmentioning

confidence: 99%

Validity of ROX Index in Prediction of Risk of Intubation in Patients with COVID-19 Pneumonia

Suliman

Abdelgawad

Farrag

et al. 2020

Advances in Respiratory Medicine

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Introduction: One important concern during the management of COVID-19 pneumonia patients with acute hypoxemic respiratory failure is early anticipation of the need for intubation. ROX is an index that can help in identification of patients with low and those with high risk of intubation. So, this study was planned to validate the diagnostic accuracy of the ROX index for prediction of COVID-19 pneumonia outcome (the need for intubation) and, in addition, to underline the significant association of the ROX index with clinical, radiological, demographic data. Material and methods: Sixty-nine RT-PCR positive COVID-19 patients were enrolled. The following data were collected: medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment. Results: All patients with severe COVID-19 infection (100%) were intubated (50% of them on the 3 rd day of admission), but only 38% of patients with moderate COVID-19 infection required intubation (all of them on the 3 rd day of admission). The ROX index on the 1 st day of admission was significantly associated with the presence of comorbidities, COVID-19 clinical classification, CT findings and intubation (p ≤ 0.001 for each of them). Regression analysis showed that sex and ROX.1 are the only significant independent predictors of intubation [AOR (95% CI): 16.9 (2.4-117), 0.77 (0.69-0.86)], respectively. Cut-off point of the ROX index on the 1 st day of admission was ≤ 25.26 (90.2% of sensitivity and 75% of specificity). Conclusions: ROX is a simple noninvasive promising tool for predicting discontinuation of high-flow oxygen therapy and could be used in the assessment of progress and the risk of intubation in COVID-19 patients with pneumonia.

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Section: Discussionmentioning

confidence: 99%

Validity of ROX Index in Prediction of Risk of Intubation in Patients with COVID-19 Pneumonia

Suliman

Abdelgawad

Farrag

et al. 2020

Advances in Respiratory Medicine

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“…Thus, using serial measurements, we can easily identify patients on HFNT therapy in whom IMV should be considered based on changes in ROX. 37…”

Section: Discussionmentioning

confidence: 99%

“…Thus, using serial measurements, we can easily identify patients on HFNT therapy in whom IMV should be considered based on changes in ROX. 37 Theoretically, the ROX can easily identify patients shifting from L-phenotype to H-phenotype (lower SF ratios and higher respiratory drive), thus minimizing subsequent risks of P-SILI. Another advantage of using the ROX index is its noninvasive nature based on readily available clinical parameters.…”

Section: Prediction Modelmentioning

confidence: 99%

ROX Index Predicts Intubation in Patients with COVID-19 Pneumonia and Moderate to Severe Hypoxemic Respiratory Failure Receiving High Flow Nasal Therapy

Patel

Chowdhury

Mills

et al. 2020

Preprint

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Introduction Use of high flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concern for increased healthcare worker transmission and delays in invasive mechanical Ventilation (IMV). Methods A retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from March 10, 2020, to May 17, 2020 with moderate to severe respiratory failure treated with High Flow nasal therapy (HFNT). HFNT patients were divided into two groups: HFNT only and HFNT progressed to IMV. The primary outcome was the ability of the ROX index to predict the need of IMV. Results Of the 837 patients with COVID-19, 129 met inclusion criteria. The mean age was 60.8 (±13.6) years, BMI 32.6 (±8), 58 (45 %) were female, 72 (55.8%) were African American, 40 (31%) Hispanic. 48 (37.2%) were smokers. Mean time to intubation was 2.5 days (± 3.3). ROX index of less than 5 at HFNT initiation was predictive of progression to IMV (OR = 2.137, p = 0,052). Any decrease in ROX index after HFNT initiation was predictive of intubation (OR= 14.67, p <0.0001). ΔROX (<=0 versus >0), peak D-dimer >4000 and admission GFR < 60 ml/min were very strongly predictive of need for IMV (ROC = 0.86, p=). Mortality was 11.2% in HFNT only group versus 47.5% in the HFNT progressed to IMV group (p,0.0001). Mortality and need for pulmonary vasodilators were higher in the HNFT progressed to IMV group. Conclusion ROX index is a valuable, noninvasive tool to evaluate patients with moderate to severe hypoxemic respiratory failure in COVID-19 treated with HFNT. ROX helps predicts need for IMV and thus limiting morbidity and mortality associated with IMV.

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“…[56][57][58] The ROX index is likely to be useful because it requires simple input (SpO 2 / FiO 2 and respiratory rate) and is easy to calculate at the bedside. 59 During the supine periods between awake proning, oral intake is to be encouraged to maintain normovolemia in resource-limited settings, as other resources for fluid intake are usually limited. The risk of aspiration, however, should be highlighted, especially in obese patients.…”

Section: Expert Opinionmentioning

confidence: 99%

Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

Stilma

Åkerman

Artigas

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.

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Predicting Outcomes of High-Flow Nasal Cannula for Acute Respiratory Distress Syndrome. An Index that ROX

Cited by 25 publications

References 11 publications

Validity of ROX Index in Prediction of Risk of Intubation in Patients with COVID-19 Pneumonia

Validity of ROX Index in Prediction of Risk of Intubation in Patients with COVID-19 Pneumonia

ROX Index Predicts Intubation in Patients with COVID-19 Pneumonia and Moderate to Severe Hypoxemic Respiratory Failure Receiving High Flow Nasal Therapy

Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

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