Validation of Respiratory Rate-Oxygenation Index in Patients With COVID-19–Related Respiratory Failure

Myers, Laura C.; Mark, Dustin G.; Ley, Brett; Guarnieri, Michael; Hofmeister, Melinda; Paulson, Shirley; Marelich, Gregory P.; Liu, Vincent X

doi:10.1097/ccm.0000000000005474

Cited by 21 publications

(19 citation statements)

References 12 publications

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“…In a cohort of 120 subjects, Vega et al 30 reported that, after 12 h of HFNC therapy, the optimal ROX cutoff was 5.99. Myers et al 31 suggested a ROX cutoff at 12 h of 3.85 for predicting the need for mechanical ventilation in COVID-19. Chandel et al 32 focused on using the ROX index to predict success of HFNC, rather than failure, in subjects with COVID-19, and found that, among those not intubated or weaned from HFNC after 12 h, a ROX index score > 3.0 had a sensitivity of 85.3% and specificity of 51.1% for successful treatment (ie, not needing intubation).…”

Section: Introductionmentioning

confidence: 99%

Intubation Timing in COVID-19 Based on ROX Index and Association With Patient Outcomes

et al. 2022

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BACKGROUND: Timing of intubation in COVID-19 is controversial. We sought to determine the association of the ROX (Respiratory rate-OXygenation) index defined as S pO 2 divided by F IO 2 divided by breathing frequency at the time of intubation with clinical outcomes. METHODS: We conducted a retrospective cohort study of patients with COVID-19 who were intubated by using a database composed of electronic health record data from patients with COVID-19 from 62 institutions. Multivariable logistic regression was used to evaluate the impact of ROX index score on mortality. We analyzed the ROX index as a continuous variable as well as a categorical variable by using cutoffs previously described as predicting success with high-flow nasal cannula. RESULTS: Of 1,087 subjects in the analysis group, the median age was 64 years, and more than half had diabetes; 55.2% died, 1.8% were discharged to hospice, 7.8% were discharged to home, 27.3% were discharged to another institution, and 7.8% had another disposition. Increasing age and a longer time from admission to intubation were associated with mortality. After adjusting for sex, race, age, comorbidities, and days from admission to intubation, an increasing ROX index score at the time of intubation was associated with a lower risk of death. In a logistic regression model, each increase in the ROX index score by 1 at the time of intubation was associated with an 8% reduction in odds of mortality (odds ratio 0.92, 95% CI 0.88-0.95). We also found an odds ratio for death of 0.62 (95% CI 0.47-0.81) for subjects with an ROX index score 6 4.88 at the time of intubation. CONCLUSIONS: Among a cohort of subjects with COVID-19 who were ultimately intubated, a higher ROX index at the time of intubation was positively associated with survival.

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Section: Introductionmentioning

confidence: 99%

Intubation Timing in COVID-19 Based on ROX Index and Association With Patient Outcomes

et al. 2022

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“…ROX index was initially reported by Roca et al to predict HFNO success in patients with non-COVID-19 pneumonia [9]. Later on, the ROX index was validated in COVID-19 patients as a predictive tool for HFNO success [10][11][12]. The utility of the ROX index in predicting NIV CPAP failure in COVID-19 was studied by Yousuf et al [13].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India

Sekar¹,

Sehgal²,

Kajal³

et al. 2022

Cureus

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Background: Non-invasive oxygen therapy (NIT) consists of high-flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP). NIT is routinely being used for the management of acute respiratory failure secondary to coronavirus disease-2019 (COVID-19) with variable outcomes. However, previously published studies show that NIT failure might delay endotracheal intubation and invasive mechanical ventilation and results in worse outcomes in patients with hypoxemic respiratory failure. Early prediction of failure of NIT, will help in early decision-making in initiating invasive mechanical ventilation. We retrospectively studied the predictors for NIT failure in patients with moderate to severe COVID-19.Methods: Adult patients (>18 years) admitted to the intensive care unit (ICU) with moderate to severe COVID-19 ARDS and received NIT [HFNO and CPAP non-invasive ventilation (NIV)] were included in this study. Baseline clinical and laboratory data were collected retrospectively from the electronic hospital information system. NIT failure was defined as the need for invasive mechanical ventilation after the initiation of NIT in the ICU. Univariate and multivariate logistic regression analyses were used to find out the possible predictors of NIT failure. Results: Out of 254 patients admitted to ICU, 127 patients were initiated NIT at admission to ICU. During the course of the ICU stay, 33 (26%) patients subsequently required invasive mechanical ventilation (NIT failure). Respiratory rate-oxygenation index (ROX index) of <2.97 at two hours and <3.63 at six hours of ICU admission predicted NIT failure in our cohort of patients with a high positive predictive value. Conclusion: Patient selection is crucial for successful NIT in COVID-19. Application of ROX index measured in the first six hours of ICU admission helps in the identification of patients at risk of NIT failure with moderate to severe COVID-19 ARDS.

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“…The rate-oxygenation index (ROXI) is the fraction of oxygen saturation, with FiO 2 as the numerator and respiratory rate as the denominator. It was also a valid predictor of the need for invasive mechanical ventilation in patients receiving HFNC [ 51 ]. Yildizdas et al [ 52 ] created an equivalent pediatric score using the respiratory rate z-score, called the pediatric rate-oxygenation index (p-ROXI).…”

Section: Clinical Predictive Scoresmentioning

confidence: 99%

Heated Humidified High-Flow Nasal Cannula in Children: State of the Art

et al. 2022

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High-flow nasal cannula (HFNC) therapy is a non-invasive ventilatory support that has gained interest over the last ten years as a valid alternative to nasal continuous positive airway pressure (nCPAP) in children with respiratory failure. Its safety, availability, tolerability, and easy management have resulted its increasing usage, even outside intensive care units. Despite its wide use in daily clinical practice, there is still a lack of guidelines to standardize the use of HFNC. The aim of this review is to summarize current knowledge about the mechanisms of action, safety, clinical effects, and tolerance of HFNC in children, and to propose a clinical practices algorithm for children with respiratory failure.

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Validation of Respiratory Rate-Oxygenation Index in Patients With COVID-19–Related Respiratory Failure

Cited by 21 publications

References 12 publications

Intubation Timing in COVID-19 Based on ROX Index and Association With Patient Outcomes

Intubation Timing in COVID-19 Based on ROX Index and Association With Patient Outcomes

Factors Associated With Non-invasive Oxygen Therapy Failure in COVID-19 Pneumonia: A Single Center, Retrospective Study in a Tertiary Hospital in North India

Heated Humidified High-Flow Nasal Cannula in Children: State of the Art

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