Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure : The utility of the ROX index
Copyright © 2016 Elsevier Inc. All rights reserved..
PURPOSE: The purpose of the study is to describe early predictors and to develop a prediction tool that accurately identifies the need for mechanical ventilation (MV) in pneumonia patients with hypoxemic acute respiratory failure (ARF) treated with high-flow nasal cannula (HFNC).
MATERIALS AND METHODS: This is a 4-year prospective observational 2-center cohort study including patients with severe pneumonia treated with HFNC. High-flow nasal cannula failure was defined as need for MV. ROX index was defined as the ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate.
RESULTS: One hundred fifty-seven patients were included, of whom 44 (28.0%) eventually required MV (HFNC failure). After 12 hours of HFNC treatment, the ROX index demonstrated the best prediction accuracy (area under the receiver operating characteristic curve 0.74 [95% confidence interval, 0.64-0.84]; P<.002). The best cutoff point for the ROX index was estimated to be 4.88. In the Cox proportional hazards model, a ROX index greater than or equal to 4.88 measured after 12 hours of HFNC was significantly associated with a lower risk for MV (hazard ratio, 0.273 [95% confidence interval, 0.121-0.618]; P=.002), even after adjusting for potential confounding.
CONCLUSIONS: In patients with ARF and pneumonia, the ROX index can identify patients at low risk for HFNC failure in whom therapy can be continued after 12 hours.
| Errataetall: |
CommentIn: Intensive Care Med. 2020 Nov;46(11):2094-2095. - PMID 32737522 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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| Enthalten in: |
Journal of critical care - 35(2016) vom: 01. Okt., Seite 200-5 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Roca, Oriol [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory failure |
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| Anmerkungen: |
Date Completed 01.09.2017 Date Revised 02.12.2018 published: Print-Electronic CommentIn: Intensive Care Med. 2020 Nov;46(11):2094-2095. - PMID 32737522 Citation Status MEDLINE |
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| doi: |
10.1016/j.jcrc.2016.05.022 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM263031861 |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Intensive Care Med. 2020 Nov;46(11):2094-2095. - PMID 32737522 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2016 Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: The purpose of the study is to describe early predictors and to develop a prediction tool that accurately identifies the need for mechanical ventilation (MV) in pneumonia patients with hypoxemic acute respiratory failure (ARF) treated with high-flow nasal cannula (HFNC) | ||
| 520 | |a MATERIALS AND METHODS: This is a 4-year prospective observational 2-center cohort study including patients with severe pneumonia treated with HFNC. High-flow nasal cannula failure was defined as need for MV. ROX index was defined as the ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate | ||
| 520 | |a RESULTS: One hundred fifty-seven patients were included, of whom 44 (28.0%) eventually required MV (HFNC failure). After 12 hours of HFNC treatment, the ROX index demonstrated the best prediction accuracy (area under the receiver operating characteristic curve 0.74 [95% confidence interval, 0.64-0.84]; P<.002). The best cutoff point for the ROX index was estimated to be 4.88. In the Cox proportional hazards model, a ROX index greater than or equal to 4.88 measured after 12 hours of HFNC was significantly associated with a lower risk for MV (hazard ratio, 0.273 [95% confidence interval, 0.121-0.618]; P=.002), even after adjusting for potential confounding | ||
| 520 | |a CONCLUSIONS: In patients with ARF and pneumonia, the ROX index can identify patients at low risk for HFNC failure in whom therapy can be continued after 12 hours | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Acute respiratory failure | |
| 650 | 4 | |a High flow nasal cannula | |
| 650 | 4 | |a Hypoxemia | |
| 650 | 4 | |a Nasal high flow | |
| 650 | 4 | |a Oxygen therapy | |
| 650 | 4 | |a Pneumonia | |
| 650 | 7 | |a Oxygen |2 NLM | |
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| 700 | 1 | |a Messika, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Caralt, Berta |e verfasserin |4 aut | |
| 700 | 1 | |a García-de-Acilu, Marina |e verfasserin |4 aut | |
| 700 | 1 | |a Sztrymf, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Ricard, Jean-Damien |e verfasserin |4 aut | |
| 700 | 1 | |a Masclans, Joan R |e verfasserin |4 aut | |
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