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

Patel, M.; Chowdhury, Junad; Mills, Nicole; Marron, R.; Gangemi, A.J.; Dorey-Stein, Z.; Yousef, Ibraheem; Zheng, Matthew; Tragesser, Lauren; Giutrintano, J.; Gupta, Rohit; Rali, Parth; D’Alonzo, Gilbert E.; Zhao, Huaqing; Patlakh, N.; Marchetti, Nathaniel; Criner, Gerard J.; Gordon, Matthew

doi:10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a2624

Cited by 3 publications

(8 citation statements)

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“…These findings suggest that HFNC may be associated with a mortality benefit in properly selected patients (i.e., patients with severe hypoxemia but who are at low risk for immediate progression to IMV). In contrast to several earlier reports of HFNC in COVID-19–associated AHRF (27–31), we found that a ROX index less than 3.85 was a poor predictor of progression to IMV. However, the ROX index did have some utility in predicting progression to IMV when incorporated into a model with other clinical, laboratory, and demographic variables.…”

Section: Discussioncontrasting

confidence: 99%

“…To our knowledge, this is the largest cohort study investigating outcomes related to HFNC use in COVID-19. The rates of intubation and death for patients receiving HFNC in our cohort were 47.0% and 22.4%, respectively, which are comparable to those of previously published cohorts of patients with AHRF due to COVID-19 (3, 27–31, 35). These cohorts include a retrospective cohort reported by Demoule et al (3) that also used propensity score matching to compare outcomes between HFNC and matched controls.…”

Section: Discussionsupporting

confidence: 85%

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The Effectiveness of High-Flow Nasal Cannula in Coronavirus Disease 2019 Pneumonia: A Retrospective Cohort Study

Burnim

Wang

Checkley

et al. 2022

Critical Care Medicine

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High-flow nasal cannula is widely used in acute hypoxemic respiratory failure due to coronavirus disease 2019, yet data regarding its effectiveness is lacking. More evidence is needed to guide patient selection, timing of high-flow nasal cannula initiation, and resource allocation. We aimed to assess time to discharge and time to death in severe coronavirus disease 2019 in patients treated with high-flow nasal cannula compared with matched controls. We also evaluated the ability of the respiratory rate-oxygenation ratio to predict progression to invasive mechanical ventilation.DESIGN: Time-dependent propensity score matching was used to create pairs of individuals who were then analyzed in a Cox proportional-hazards regression model to estimate high-flow nasal cannula's effect on time to discharge and time to death. A secondary analysis excluded high-flow nasal cannula patients intubated within 6 hours of admission. A Cox proportional-hazards regression model was used to assess risk of invasive mechanical ventilation among high-flow nasal cannula patients stratified by respiratory rate-oxygenation. SETTING:The five hospitals of the Johns Hopkins Health System. PATIENTS:All patients who were admitted with a laboratory-confirmed diagnosis of coronavirus disease 2019 were eligible for inclusion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:High-flow nasal cannula was associated with longer median time to discharge: 10.6 days (interquartile range, 7.1-15.8 d) versus 7.8 days (interquartile range, 4.9-12.1 d). Respiratory rate-oxygenation index performed poorly in predicting ventilation or death. In the primary analysis, there was no significant association between high-flow nasal cannula and hazard of death (adjusted hazard ratio, 0.79; 95% CI, 0.57-1.09). Excluding patients intubated within 6 hours of admission, high-flow nasal cannula was associated with reduced hazard of death (adjusted hazard ratio, 0.67; 95% CI, 0.45-0.99).CONCLUSIONS: Among unselected patients with severe coronavirus disease 2019 pneumonia, high-flow nasal cannula was not associated with a statistically significant reduction in hazard of death. However, in patients not mechanically ventilated within 6 hours of admission, high-flow nasal cannula was associated with a significantly reduced hazard of death.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 85%

The Effectiveness of High-Flow Nasal Cannula in Coronavirus Disease 2019 Pneumonia: A Retrospective Cohort Study

Burnim

Wang

Checkley

et al. 2022

Critical Care Medicine

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“…Dengan demikian, terdapat dua indikator yang bermakna sebagai tanda awal dari kegagalan HFNC, yaitu nilai FiO 2 awal yang besar dan nilai FiO 2 tertinggi serta nilai rasio S/F awal yang kecil dan rasio S/F yang terendah. 17 Selain itu, dari Kannikeswaran dkk 18 pada artikel tahun 2022 mendapati hasil dari sebuah studi kohort prospektif bahwa pasien anak usia <2 tahun yang memiliki skor indeks ROX pada kuartil terendah (<5,39) memiliki tiga kali risiko membutuhkan bantuan ventilasi mekanik dibandingkan dengan grup yang memiliki skor indeks di kuartil atas (>8,21) (OR 3,1; 95%CI [1,[3][4][5][6][7]5]; p=0,02).…”

Section: Indeks Rox Pada Pasien Anakunclassified

“…Beberapa penelitian pada pasien dewasa telah menunjukkan bahwa indeks ROX efektif sebagai prediktor keberhasilan dan kegagalan HFNC, bahkan penelitian indeks ROX berkembang pada pasien Covid-19 dewasa dengan hasil yang mendukung. 4,5 Berbeda pada populasi anak, tidak banyak ditemukan penelitian mengenai penggunaan indeks ROX pada anak yang menggunakan HFNC. Padahal, penggunaan HFNC pada ruang rawat intensif anak mengalami peningkatan dan menjadi salah satu modalitas terapi oksigen utama pada kegawatdaruratan gagal napas akut.…”

unclassified

Penggunaan Indeks Respiratory-Oxygnation dalam Menentukan Keberhasilan Terapi Oksigen High Flow Nasal Cannula pada Anak Sakit Kritis dengan Distres Napas

Saputra

Handayani²,

Kaffah³

2023

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Indeks ROX merupakan rasio saturasi oksigen terhadap fraksi oksigen pada tiap laju pernapasan per menit. Beberapa studi melaporkan indeks ROX bermanfaat sebagai prediktor keberhasilan terapi HFNC pada pasien dewasa. Indeks ROX membantu memprediksi kebutuhan ventilasi mekanik invasif, sehingga menurunkan angka mortalitas dan morbiditas yang terkait dengan penggunaan ventilasi mekanik. Namun literatur mengenai penggunaan indeks ROX pada populasi anak sangat terbatas. Padahal penggunaan HFNC pada pasien anak mengalami peningkatan pesat dan sampai saat ini belum ada indikator keberhasilan HFNC yang bersifat objektif dan baku untuk pasien anak. Tinjauan pustaka ini akan membahas indikasi pemberian HFNC, mekanisme kerja, dan penggunaan indeks ROX pada pasien anak sakit kritis dengan distres napas.

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“…However, it is known that severe respiratory failure caused by COVID-19 has a feature and phenotype different from the clinical features of known ARDS 12 . A re-evaluation of the effectiveness of the ROX index was needed in this special patient group, and different cut-off values have been reported, albeit limited, in the literature 13 – 15 .…”

Section: Introductionmentioning

confidence: 99%

Factors affecting the failure of High Flow Nasal Cannula Oxygen therapy in Intensive Care follow-up of COVID-19 Severe Respiratory Failure

et al. 2022

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AimAcute respiratory distress syndrome is the primary clinical problem that requires follow-up at the intensive care units. High Flow Nasal Cannula Oxygen Therapy has become an increasingly popular method by reducing the need for intubation but determining which patient will benefit from High Flow Nasal Cannula Oxygen Therapy is an important issue. Methods Seventy patients who followed up with acute respiratory distress syndrome related COVID-19 treated with High Flow Nasal Cannula Oxygen Systems as initial treatment at the intensive care units were retrospectively review. The primary endpoint of this study is to identify factors correlating with failure (mortality and invasive mechanical ventilator requirement) of High Flow Nasal Cannula Oxygen Therapy in the treatment of COVID-19-related severe ARDS. The secondary aim of this study is to determine the ROX index measured at the 12th hour, which will indicate the need for intubation in critically ill patients followed up with HFNC.Results Advanced age, male gender, and low ROX index were independent variables affecting High Flow Nasal Cannula Oxygen Therapy failure. While mortality was lowest in patients who completed the process with High Flow Nasal Cannula Oxygen Therapy treatment, patients who were intubated early (12-24h) had lower mortality than those who were intubated later (>24h) (Mortality rates were %4,3 ,%65,6 ,%93,3 respectively). The cut-off value for ROX index, which will indicate the need for intubation, was found to be 2.84. ConclusionHigh Flow Nasal Cannula Oxygen Therapy can be an effective treatment method in the follow-up of patients with COVID-19-related severe respiratory failure. Despite this, the requirement for intubation develops in two third of the patients. Early intubation reduces mortality in patients who fail High Flow Nasal Cannula Oxygen Therapy, and the easily calculated ROX index is a useful parameter to determine the need for intubation.

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

Cited by 3 publications

References 0 publications

The Effectiveness of High-Flow Nasal Cannula in Coronavirus Disease 2019 Pneumonia: A Retrospective Cohort Study

The Effectiveness of High-Flow Nasal Cannula in Coronavirus Disease 2019 Pneumonia: A Retrospective Cohort Study

Penggunaan Indeks Respiratory-Oxygnation dalam Menentukan Keberhasilan Terapi Oksigen High Flow Nasal Cannula pada Anak Sakit Kritis dengan Distres Napas

Factors affecting the failure of High Flow Nasal Cannula Oxygen therapy in Intensive Care follow-up of COVID-19 Severe Respiratory Failure

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