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Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index.
J Crit Care. 2016 10; 35:200-5.JC

Abstract

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.

Authors+Show Affiliations

Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: oroca@vhebron.net.AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France.Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spains also been shown.Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.AP-HP, Hôpital Antoine Béclère, Service de Réanimation Polyvalente et Surveillance Continue, F-92140 Clamart, France.AP-HP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, F-92700 Colombes, France; INSERM, IAME, UMR 1137, F-75018 Paris, France; Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France.Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Critical Care Department, Mar University Hospital, Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27481760

Citation

Roca, Oriol, et al. "Predicting Success of High-flow Nasal Cannula in Pneumonia Patients With Hypoxemic Respiratory Failure: the Utility of the ROX Index." Journal of Critical Care, vol. 35, 2016, pp. 200-5.
Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016;35:200-5.
Roca, O., Messika, J., Caralt, B., García-de-Acilu, M., Sztrymf, B., Ricard, J. D., & Masclans, J. R. (2016). Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. Journal of Critical Care, 35, 200-5. https://doi.org/10.1016/j.jcrc.2016.05.022
Roca O, et al. Predicting Success of High-flow Nasal Cannula in Pneumonia Patients With Hypoxemic Respiratory Failure: the Utility of the ROX Index. J Crit Care. 2016;35:200-5. PubMed PMID: 27481760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. AU - Roca,Oriol, AU - Messika,Jonathan, AU - Caralt,Berta, AU - García-de-Acilu,Marina, AU - Sztrymf,Benjamin, AU - Ricard,Jean-Damien, AU - Masclans,Joan R, Y1 - 2016/05/31/ PY - 2016/02/23/received PY - 2016/05/18/revised PY - 2016/05/23/accepted PY - 2016/8/3/entrez PY - 2016/8/3/pubmed PY - 2017/9/2/medline KW - Acute respiratory failure KW - High flow nasal cannula KW - Hypoxemia KW - Nasal high flow KW - Oxygen therapy KW - Pneumonia SP - 200 EP - 5 JF - Journal of critical care JO - J Crit Care VL - 35 N2 - 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. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/27481760/Predicting_success_of_high_flow_nasal_cannula_in_pneumonia_patients_with_hypoxemic_respiratory_failure:_The_utility_of_the_ROX_index_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(16)30094-6 DB - PRIME DP - Unbound Medicine ER -