Tags

Type your tag names separated by a space and hit enter

Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate.
J Intensive Care. 2020; 8:41.JI

Abstract

Background

The ROX index (ratio of pulse oximetry/FIO2 to respiratory rate) has been validated to predict high flow nasal cannula therapy (HFNC) outcomes in patients with pneumonia. We evaluated a modified ROX index incorporating heart rate (HR) in patients initiated on HFNC for acute hypoxemic respiratory failure and as a preventative treatment following planned extubation.

Methods

We performed a prospective observational cohort study of 145 patients treated with HFNC. ROX-HR index was defined as the ratio of ROX index over HR (beats/min), multiplied by a factor of 100. Evaluation was performed using area under the receiving operating characteristic curve (AUROC) and cutoffs assessed for prediction of HFNC failure: defined as the need for mechanical ventilation.

Results

Ninety-nine (68.3%) and 46 (31.7%) patients were initiated on HFNC for acute hypoxemic respiratory failure and following a planned extubation, respectively. The majority (86.9%) of patients had pneumonia as a primary diagnosis, and 85 (56.6%) patients were immunocompromised. Sixty-one (42.1%) patients required intubation (HFNC failure). Amongst patients on HFNC for acute respiratory failure, HFNC failure was associated with a lower ROX and ROX-HR index recorded at time points between 1 and 48 h. Within the first 12 h, both indices performed with the highest AUROC at 10 h as follows: 0.723 (95% CI 0.605-0.840) and 0.739 (95% CI 0.626-0.853) for the ROX and ROX-HR index respectively. A ROX-HR index of > 6.80 was significantly associated with a lower risk of HFNC failure (hazard ratio 0.301 (95% CI 0.143-0.663)) at 10 h. This association was also observed at 2, 6, 18, and 24h, even with correction for potential confounding factors. For HFNC initiated post-extubation, only the ROX-HR index remained significantly associated with HFNC failure at all recorded time points between 1 and 24 h. A ROX-HR > 8.00 at 10 h was significantly associated with a lower risk of HFNC failure (hazard ratio 0.176 (95% CI 0.051-0.604)).

Conclusion

While validation studies are required, the ROX-HR index appears to be a promising tool for early identification of treatment failure in patients initiated on HFNC for acute hypoxemic respiratory failure or as a preventative treatment after a planned extubation.

Authors+Show Affiliations

Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore.Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore.Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore. Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore.Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore. Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856 Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32587703

Citation

Goh, Ken Junyang, et al. "Early Prediction of High Flow Nasal Cannula Therapy Outcomes Using a Modified ROX Index Incorporating Heart Rate." Journal of Intensive Care, vol. 8, 2020, p. 41.
Goh KJ, Chai HZ, Ong TH, et al. Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate. J Intensive Care. 2020;8:41.
Goh, K. J., Chai, H. Z., Ong, T. H., Sewa, D. W., Phua, G. C., & Tan, Q. L. (2020). Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate. Journal of Intensive Care, 8, 41. https://doi.org/10.1186/s40560-020-00458-z
Goh KJ, et al. Early Prediction of High Flow Nasal Cannula Therapy Outcomes Using a Modified ROX Index Incorporating Heart Rate. J Intensive Care. 2020;8:41. PubMed PMID: 32587703.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate. AU - Goh,Ken Junyang, AU - Chai,Hui Zhong, AU - Ong,Thun How, AU - Sewa,Duu Wen, AU - Phua,Ghee Chee, AU - Tan,Qiao Li, Y1 - 2020/06/22/ PY - 2020/03/17/received PY - 2020/06/10/accepted PY - 2020/6/27/entrez PY - 2020/6/27/pubmed PY - 2020/6/27/medline KW - Acute respiratory failure KW - High flow nasal cannula KW - High flow oxygen therapy KW - Pneumonia KW - Postextubation SP - 41 EP - 41 JF - Journal of intensive care JO - J Intensive Care VL - 8 N2 - Background: The ROX index (ratio of pulse oximetry/FIO2 to respiratory rate) has been validated to predict high flow nasal cannula therapy (HFNC) outcomes in patients with pneumonia. We evaluated a modified ROX index incorporating heart rate (HR) in patients initiated on HFNC for acute hypoxemic respiratory failure and as a preventative treatment following planned extubation. Methods: We performed a prospective observational cohort study of 145 patients treated with HFNC. ROX-HR index was defined as the ratio of ROX index over HR (beats/min), multiplied by a factor of 100. Evaluation was performed using area under the receiving operating characteristic curve (AUROC) and cutoffs assessed for prediction of HFNC failure: defined as the need for mechanical ventilation. Results: Ninety-nine (68.3%) and 46 (31.7%) patients were initiated on HFNC for acute hypoxemic respiratory failure and following a planned extubation, respectively. The majority (86.9%) of patients had pneumonia as a primary diagnosis, and 85 (56.6%) patients were immunocompromised. Sixty-one (42.1%) patients required intubation (HFNC failure). Amongst patients on HFNC for acute respiratory failure, HFNC failure was associated with a lower ROX and ROX-HR index recorded at time points between 1 and 48 h. Within the first 12 h, both indices performed with the highest AUROC at 10 h as follows: 0.723 (95% CI 0.605-0.840) and 0.739 (95% CI 0.626-0.853) for the ROX and ROX-HR index respectively. A ROX-HR index of > 6.80 was significantly associated with a lower risk of HFNC failure (hazard ratio 0.301 (95% CI 0.143-0.663)) at 10 h. This association was also observed at 2, 6, 18, and 24h, even with correction for potential confounding factors. For HFNC initiated post-extubation, only the ROX-HR index remained significantly associated with HFNC failure at all recorded time points between 1 and 24 h. A ROX-HR > 8.00 at 10 h was significantly associated with a lower risk of HFNC failure (hazard ratio 0.176 (95% CI 0.051-0.604)). Conclusion: While validation studies are required, the ROX-HR index appears to be a promising tool for early identification of treatment failure in patients initiated on HFNC for acute hypoxemic respiratory failure or as a preventative treatment after a planned extubation. SN - 2052-0492 UR - https://www.unboundmedicine.com/medline/citation/32587703/Early_prediction_of_high_flow_nasal_cannula_therapy_outcomes_using_a_modified_ROX_index_incorporating_heart_rate_ L2 - https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-020-00458-z DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.