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An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy.
Am J Respir Crit Care Med. 2019 06 01; 199(11):1368-1376.AJ

Abstract

Rationale:

One important concern during high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemic respiratory failure is to not delay intubation.

Objectives:

To validate the diagnostic accuracy of an index (termed ROX and defined as the ratio of oxygen saturation as measured by pulse oximetry/FiO2 to respiratory rate) for determining HFNC outcome (need or not for intubation).

Methods:

This was a 2-year multicenter prospective observational cohort study including patients with pneumonia treated with HFNC. Identification was through Cox proportional hazards modeling of ROX association with HFNC outcome. The most specific cutoff of the ROX index to predict HFNC failure and success was assessed.

Measurements and Main Results:

Among the 191 patients treated with HFNC in the validation cohort, 68 (35.6%) required intubation. The prediction accuracy of the ROX index increased over time (area under the receiver operating characteristic curve: 2 h, 0.679; 6 h, 0.703; 12 h, 0.759). ROX greater than or equal to 4.88 measured at 2 (hazard ratio, 0.434; 95% confidence interval, 0.264-0.715; P = 0.001), 6 (hazard ratio, 0.304; 95% confidence interval, 0.182-0.509; P < 0.001), or 12 hours (hazard ratio, 0.291; 95% confidence interval, 0.161-0.524; P < 0.001) after HFNC initiation was consistently associated with a lower risk for intubation. A ROX less than 2.85, less than 3.47, and less than 3.85 at 2, 6, and 12 hours of HFNC initiation, respectively, were predictors of HFNC failure. Patients who failed presented a lower increase in the values of the ROX index over the 12 hours. Among components of the index, oxygen saturation as measured by pulse oximetry/FiO2 had a greater weight than respiratory rate.

Conclusions:

In patients with pneumonia with acute respiratory failure treated with HFNC, ROX is an index that can help identify those patients with low and those with high risk for intubation. Clinical trial registered with www.clinicaltrials.gov (NCT02845128).

Authors+Show Affiliations

1 Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute and. 2 Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.1 Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute and. 3 Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.4 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France. 5 INSERM, Infection Antimicrobials Modelling Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France. 6 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.7 Critical Care Department, Hospital del Mar, Mar Research Institute, Barcelona, Spain.8 Service de Réanimation Polyvalente et Surveillance Continue, Hôpital Antoine Béclère, AP-HP, Clamart, France. 9 INSERM U999: Pulmonary Hypertension, Physiopathologie et Innovation Thérapeutique, Hôpital Marie Lannelongue, Le Plessis Robinson, France.10 Critical Care Department, Virgen de la Salud University Hospital, Toledo, Spain.1 Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute and.11 Réanimation Médicale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France. 12 Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France; and. 13 INSERM, Centre d'Investigation Clinique-1402, Equipe 5 Acute Lung Injury and Ventilatory Support, Poitiers, France.3 Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. 2 Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 7 Critical Care Department, Hospital del Mar, Mar Research Institute, Barcelona, Spain.4 Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France. 5 INSERM, Infection Antimicrobials Modelling Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France. 6 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30576221

Citation

Roca, Oriol, et al. "An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy." American Journal of Respiratory and Critical Care Medicine, vol. 199, no. 11, 2019, pp. 1368-1376.
Roca O, Caralt B, Messika J, et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. Am J Respir Crit Care Med. 2019;199(11):1368-1376.
Roca, O., Caralt, B., Messika, J., Samper, M., Sztrymf, B., Hernández, G., García-de-Acilu, M., Frat, J. P., Masclans, J. R., & Ricard, J. D. (2019). An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. American Journal of Respiratory and Critical Care Medicine, 199(11), 1368-1376. https://doi.org/10.1164/rccm.201803-0589OC
Roca O, et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. Am J Respir Crit Care Med. 2019 06 1;199(11):1368-1376. PubMed PMID: 30576221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. AU - Roca,Oriol, AU - Caralt,Berta, AU - Messika,Jonathan, AU - Samper,Manuel, AU - Sztrymf,Benjamin, AU - Hernández,Gonzalo, AU - García-de-Acilu,Marina, AU - Frat,Jean-Pierre, AU - Masclans,Joan R, AU - Ricard,Jean-Damien, PY - 2018/12/24/pubmed PY - 2020/2/25/medline PY - 2018/12/22/entrez KW - acute respiratory failure KW - high-flow nasal cannula KW - nasal high flow KW - pneumonia SP - 1368 EP - 1376 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 199 IS - 11 N2 - Rationale: One important concern during high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemic respiratory failure is to not delay intubation. Objectives: To validate the diagnostic accuracy of an index (termed ROX and defined as the ratio of oxygen saturation as measured by pulse oximetry/FiO2 to respiratory rate) for determining HFNC outcome (need or not for intubation). Methods: This was a 2-year multicenter prospective observational cohort study including patients with pneumonia treated with HFNC. Identification was through Cox proportional hazards modeling of ROX association with HFNC outcome. The most specific cutoff of the ROX index to predict HFNC failure and success was assessed. Measurements and Main Results: Among the 191 patients treated with HFNC in the validation cohort, 68 (35.6%) required intubation. The prediction accuracy of the ROX index increased over time (area under the receiver operating characteristic curve: 2 h, 0.679; 6 h, 0.703; 12 h, 0.759). ROX greater than or equal to 4.88 measured at 2 (hazard ratio, 0.434; 95% confidence interval, 0.264-0.715; P = 0.001), 6 (hazard ratio, 0.304; 95% confidence interval, 0.182-0.509; P < 0.001), or 12 hours (hazard ratio, 0.291; 95% confidence interval, 0.161-0.524; P < 0.001) after HFNC initiation was consistently associated with a lower risk for intubation. A ROX less than 2.85, less than 3.47, and less than 3.85 at 2, 6, and 12 hours of HFNC initiation, respectively, were predictors of HFNC failure. Patients who failed presented a lower increase in the values of the ROX index over the 12 hours. Among components of the index, oxygen saturation as measured by pulse oximetry/FiO2 had a greater weight than respiratory rate. Conclusions: In patients with pneumonia with acute respiratory failure treated with HFNC, ROX is an index that can help identify those patients with low and those with high risk for intubation. Clinical trial registered with www.clinicaltrials.gov (NCT02845128). SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/30576221/An_Index_Combining_Respiratory_Rate_and_Oxygenation_to_Predict_Outcome_of_Nasal_High_Flow_Therapy_ L2 - https://www.atsjournals.org/doi/10.1164/rccm.201803-0589OC?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -