https://doi.org/10.4081/monaldi.2023.2509
Utility and timing of the respiratory rate-oxygenation index in the prediction of high-flow oxygen therapy failure in acute hypoxemic respiratory failure of infective etiology: a prospective observational study
Submitted: December 18, 2022
Accepted: May 4, 2023
Published: May 16, 2023
Accepted: May 4, 2023
Abstract Views: 828
PDF: 236
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
During and following the COVID-19 pandemic, the world has witnessed a surge in high-flow oxygen therapy (HFOT) use. The ability to provide high oxygenation levels with remarkable comfort levels has been the grounds for the same. Despite the advantages, delays in intubation leading to poor overall outcomes have been noticed in subgroups of patients on HFOT. The respiratory rate-oxygenation (ROX) index has been proposed to be a useful indicator to predict HFOT success. In this study, we have examined the utility of the ROX index prospectively in cases of acute hypoxemic respiratory failure (AHRF) due to infective etiologies. A total of 70 participants were screened, and 55 were recruited for the study. The majority of participants were males (56.4%), with diabetes mellitus being the most common comorbidity (29.1%). The mean age of the study subjects was 46.27±15.6 years. COVID-19 (70.9%) was the most common etiology for AHRF, followed by scrub typhus (21.8%). 19 (34.5%) experienced HFOT failure, and 9 (16.4%) subjects died during the study period. Demographic characteristics did not differ between either of the two groups (HFOT success versus failure and survived group versus expired group). The ROX index was significantly different between the HFOT success versus failure group at baseline, 2, 4, 6, 12, and 24 hours. The best cut-offs of the ROX index at baseline and 2 hours were 4.4 (sensitivity 91.7%, specificity 86.7%) and 4.3 (sensitivity 94.4% and specificity 86.7%), respectively. The ROX index was found to be an efficient tool in predicting HFOT failure in cases of AHRF with infective etiology.
Goligher EC, Slutsky AS. Not just oxygen? Mechanisms of benefit from high-flow nasal cannula in hypoxemic respiratory failure. Am J Respir Crit Care Med 2017;195:1128-31.
Frat JP, Ragot S, Girault C, et al. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial. Lancet Respir Med 2016;4:646-52.
Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372:2185-96.
Ferreyro BL, Angriman F, Munshi L, et al. Association of non-invasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis. JAMA 2020;32:57-67.
Panadero C, Abad-Fernández A, Rio-Ramirez MT, et al. High-flow nasal cannula for acute respiratory distress syndrome (ARDS) due to COVID-19. Multidiscip Respir Med 2020;15:693.
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;199:1368-76.
Webb LV, Chahine R, Aban I, et al. Predicting high-flow nasal cannula therapy outcomes using the ROX-HR index in the pediatric ICU. Respir Care 2022;respcare.09765.
Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016;315:788-800.
Kang BJ, Koh Y, Lim CM, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med 2015;41:623-32.
Frat JP, Ragot S, Thille AW. High-flow nasal cannula oxygen in respiratory failure. N Engl J Med 2015;373:1374-5.
Carrillo A, Gonzalez-Diaz G, Ferrer M, et al. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med 2012;38:458-66.
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.
Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome. Lancet 2021;398:622-37.
Calfee CS, Eisner MD, Ware LB, et al. Trauma-associated lung injury differs clinically and biologically from acute lung injury due to other clinical disorders. Crit Care Med 2007;35:2243-50.
Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care 2015;3:15.
Hernández G, Roca O, Colinas L. High-flow nasal cannula support therapy: new insights and improving performance. Crit Care 2017;21:62.
Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med 2009;35:996-1003.
Smith TA, Davidson PM, Jenkins CR, Ingham JM. Life behind the mask: the patient experience of NIV. Lancet Respir Med 2015;3:8-10.
Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care 2010;55:408-13.
Ritchie JE, Williams AB, Gerard C, Hockey H. Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures. Anaesth Intensive Care 2011;39:1103-10.
Kangelaris KN, Ware LB, Wang CY, et al. Timing of intubation and clinical outcomes in adults with acute respiratory distress syndrome. Crit Care Med 2016;44:120-9.
Bauer PR, Gajic O, Nanchal R, et al. Association between timing of intubation and outcome in critically ill patients: a secondary analysis of the ICON audit. J Crit Care 2017;42:1-5.
Yamamoto R, Kaito D, Homma K, et al. Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019. Crit Care 2022;26:124.
Esteban A, Frutos-Vivar F, Ferguson ND, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004;350:2452-60.
McKay B, Meyers M, Rivard L, et al. Comparison of early and late intubation in COVID-19 and Its effect on mortality. Int J Environ Res Public Health 2022;19:3075.
Hu M, Zhou Q, Zheng R, et al. Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. BMC Pulm Med 2020;20:324.
Vega ML, Dongilli R, Olaizola G, et al. COVID-19 Pneumonia and ROX index: time to set a new threshold for patients admitted outside the ICU. Pulmonology 2022;28:13-7.
Zucman N, Mullaert J, Roux D, et al. Prediction of outcome of nasal high flow use during COVID-19-related acute hypoxemic respiratory failure. Intensive Care Med 2020;46:1924-6.
Calligaro GL, Lalla U, Audley G, et al. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: a multi-centre prospective observational study. EClinicalMedicine 2020;28:100570.
Blez D, Soulier A, Bonnet F, et al. Monitoring of high-flow nasal cannula for SARS-CoV-2 severe pneumonia: less is more, better look at respiratory rate. Intensive Care Med 2020;46:2094-5.
Xu J, Yang X, Huang C, et al. A novel risk-stratification models of the high-flow nasal cannula therapy in COVID-19 patients with hypoxemic respiratory failure. Front Med 2020;7:607821.
Chandel A, Patolia S, Brown AW, et al. High-flow nasal cannula therapy in COVID-19: using the ROX index to predict success. Respir Care 2021;66:909-19.
Ethics Approval
All approvals (ethical and review board) were obtained before screening the first patient. The Institutional Review Board-approved study protocol was also cleared by the Biomedical Research Ethics Committee of the Institute via approval letter number BREC/Th/20/02, dated September 2, 2020.How to Cite
Chaudhari, Pramod, Pawan Kumar Singh, Manjunath Govindagoudar, Vinod Sharma, Puneet Saxena, Aman Ahuja, Lokesh Lalwani, and Dhruva Chaudhry. 2023. “Utility and Timing of the Respiratory Rate-Oxygenation Index in the Prediction of High-Flow Oxygen Therapy Failure in Acute Hypoxemic Respiratory Failure of Infective Etiology: A Prospective Observational Study”. Monaldi Archives for Chest Disease 94 (1). https://doi.org/10.4081/monaldi.2023.2509.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Muhammad Ijaz, Muhammad Jaffar Khan, Jawad Khan, . Usama, Association of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava, Revolving door respiratory patients: A rehabilitative perspective , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Gabriele Valli, Francesca De Marco, Maria Teresa Spina, Valentina Valeriano, Antonello Rosa, Valentina Minerva, Enrico Mirante, Maria Pia Ruggieri, Francesco Rocco Pugliese, A pilot study on the application of the current European guidelines for the management of acute coronary syndrome without elevation of ST segment (NSTEMI) in the Emergency Department setting in the Italian region Lazio , Monaldi Archives for Chest Disease: Vol. 82 No. 4 (2014): Cardiac series
- Michele Vitacca, Luca Barbano, Daniele Colombo, Olivia Leoni, Enrico Guffanti, Prevalence and variability of use of home mechanical ventilators, positive airway pressure and oxygen devices in the Lombardy region, Italy , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Francesco Barillà , Concetta Torromeo, Riccardo Iorio, Luigina Porco, Vincenzo Paravati, Carlo Gaudio, Antiplatelet therapy in elderly patients with acute coronary syndrome: Between scientific evidence and future perspectives , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- G. Caramori, M. Fabbri, D. Paioli, F. Falcone, C. Severino, G. Felisatti, O. Arar, I.M. Adcock, K. Fan Chung, P.J. Barnes, A. Ciaccia, A. Papi, Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study , Monaldi Archives for Chest Disease: Vol. 63 No. 2 (2005): Pulmonary series
- Claudio F. Donner, Sandro Amaducci, Elena Bacci, Sandra Baldacci, Maria L. Bartoli, Gianfranco M. Beghi, Alida Benfante, Sara Brighindi, Lucio Casali, Daniela Castiglia, Mario Cazzola, Alessandro Celi, Silvana Cianchetti, Giorgio Colombo, Claudia Crimi, Federico L. Dente, Giuseppe Di Maria, Annalisa Di Maria, Manuela Latorre, Federico Lavorini, Sara Maio, Claudia Mannini, Riccardo Messina, Pier Luigi Paggiaro, Patrizia Pignatti, David Price, Nicola Scichilone, Marzia Simoni, Antonio Spanevello, Martina Stagno d’Alcontres, Shawna Tan, Roberto Torchio, Giovanni Viegi, Dina Visca, Emiel F.M. Wouters, Shaylynn Yu Hui Xin, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Federico Raimondi, Stefano Centanni, Fabrizio Luppi, Stefano Aliberti, Francesco Blasi, Paola Rogliani, Claudio Micheletto, Marco Contoli, Alessandro Sanduzzi Zamparelli, Marialuisa Bocchino, Paolo Busatto, Luca Novelli, Simone Pappacena, Luca Malandrino, Giorgio Lorini, Greta Cairoli, Fabiano Di Marco, Respiratory rate-oxygenation index on the 3rd day is the best predictor of treatment failure in COVID-19 patients , Monaldi Archives for Chest Disease: Early Access
- I. Blanco, H. Canto, J. Flóres, C. Camblor, V. Cárcaba, F.J. de Serres, S. Janciauskiene, E.F. Bustillo, Long-term augmentation therapy with Alpha-1 Antitrypsin in an MZ-AAT severe persistent asthma , Monaldi Archives for Chest Disease: Vol. 69 No. 4 (2008): Pulmonary series
- L. Barbano, E. Bertella, M. Vitacca, Episodic medical home interventions in severe bedridden Chronic Respiratory Failure patients: a 4 year retrospective study , Monaldi Archives for Chest Disease: Vol. 71 No. 3 (2009): Pulmonary series
You may also start an advanced similarity search for this article.
