ROX index as predictor of high flow nasal cannula therapy success in acute respiratory failure due to SARS-CoV-2. (November 2021)

• Record Type: Journal Article
• Authors: Ferrer, Santos; Sancho, Jesús; Bocigas, Irene; Bures, Enric; Mora, Heidi; Monclou, Erik; Mulet, Alba; Quezada, Antonio; Royo, Pablo; Signes-Costa, Jaime
• Is Part Of: Respiratory medicine. Volume 189(2021)
• Publication Date: 2021-11
• Subjects: COVID-19 -- Respiratory failure -- High flow nasal cannula -- Mechanical ventilation; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2021.106638
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: High-Flow Nasal Cannula (HFNC) therapy is useful treatment in patients with acute respiratory failure (ARF). The ROX index (ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate) has been evaluated to predict success of HFNC in patients with pneumonia. Objective: The aim of this study was to determine whether the ROX Index could predict HFNC therapy success in patients with ARF due to SARS-CoV-2 pneumonia. Methods: An observational, prospective study was performed including patients admitted with ARF secondary to SARS-CoV-2 pneumonia who met criteria for HFNC therapy initiation. Demographic, radiological, laboratory and clinical course data were collected. The ROX index was calculated at 1 h, 6 h, 12 h and 24 h after starting HFNC. Results: In total 85 patients were included (age, 64.51 + 11.78 years; male, 69.4%). HFNC failed in 47 (55.3%) patients, of whom 45 (97.8%) were initially managed with noninvasive ventilation (NIV). ROX index at 24 h was the best predictor of HFNC success (AUC 0.826, 95%CI 0.593–1.00, p = 0.015) with a cut-off point of 5.35 (S 0.91, Sp 0.79, PPV 0.92, NPP 0.79). In multivariate logistic regression analysis ROX index at 24 h proved the best predictor of HFNC success. Conclusions: ROX index at 24 h with a cut-off point of 5.35 predicts HFNC success in patients with SARS-Cov-2-induced ARF. Highlights: ROX index is the most accurate predictor for HFNC therapy success in acute respiratory failure due to COVID-19. 24h ROX index (cut-off point 5.35) predicts HFNC therapy success in patients with SARS-Cov-2- and acute respiratory failure. HFNC and noninvasive ventilation as rescue therapy avoid endotracheal intubation or death in 59% of patients with COVID-19.