Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

General Research Article

Value of Rox Index to Predict Intubation and Intensive Care Unit Outcome In Patients With Respiratory Failure

Author(s): Ayshan Mammadova*, Esra Eriş, Zeynep Sena Solmaz, Ayşe Taşçı Kara, Aydın Atasoy and Gül Gürsel

Volume 17, Issue 3, 2022

Published on: 21 October, 2022

Page: [187 - 194] Pages: 8

DOI: 10.2174/1574887117666220606114549

Price: $65

Abstract

Background: Recent literature suggests that the respiratory rate oxygenation (ROX) index may be useful in predicting intubation indication in hypoxemic patients.

Objective: In this study, we evaluated the accuracy of the ROX index in predicting intubation, length of stay in the ICU, and mortality in ICU patients with hypoxemic respiratory failure with and without hypercapnia.

Methods: A single-centre retrospective cohort study of 290 patients with a preliminary diagnosis of respiratory failure were treated with low-flow oxygen systems. Demographics, medical history, clinical, laboratory, treatment, and prognostic data were obtained from the hospital's electronic records. The ROX index was calculated at the time of ICU admission.

Results: Thirty-seven percent of non-hypercapnic and 69% of hypercapnic patients were intubated (p:0.005). In hypercapnic patients, ROX: 6.9 had highest sensitivity (81%) and specificity (65%) values for intubation (p:0.005). In non-hypercapnic patients, ROX: 6.2 had the highest sensitivity (81%) and specificity (40%) values. While 11% of hypercapnic patients and 30% of non-hypercapnic patients died (p:0.05), 22% of hypercapnic patients and 33% of non-hypercapnic patients stayed in the ICU longer than 14 days (p:0.044). The highest sensitivity and specificity values were found for mortality in hypercapnic patients; for ROX value of 5.94 (sensitivity:86%, specificity:61%) and ICU stay longer than 14 days; for ROX value of 7.4 (sensitivity:71%, specificity:68%).

Conclusion: Results of our study suggest that the ROX index calculated during ICU admission can help predict intubation indication and length of ICU stay in patients with respiratory failure and hypercapnia may influence the cutoff values.

Keywords: ROX index, PaO2/FiO2, respiratory failure, intubation, intensive care unit

[1]
Vincent JL, Akça S, De Mendonça A, et al. The epidemiology of acute respiratory failure in critically ill patients(*). Chest 2002; 121(5): 1602-9.
[http://dx.doi.org/10.1378/chest.121.5.1602] [PMID: 12006450]
[2]
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(8): 788-800.
[http://dx.doi.org/10.1001/jama.2016.0291] [PMID: 26903337]
[3]
Pham T, Rubenfeld GD. Fifty years of research in ARDS the epidemiology of acute respiratory distress syndrome. A 50th birthday review. Am J Respir Crit Care Med 2017; 195(7): 860-70.
[http://dx.doi.org/10.1164/rccm.201609-1773CP] [PMID: 28157386]
[4]
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA 2012; 307(23): 2526-33.
[PMID: 22797452]
[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.
[http://dx.doi.org/10.1016/j.jcrc.2016.05.022] [PMID: 27481760]
[6]
Lemiale V, Dumas G, Demoule A, et al. Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure. Ann Intensive Care 2021; 11(1): 17.
[http://dx.doi.org/10.1186/s13613-021-00801-z] [PMID: 33501590]
[7]
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): 1368-76.
[http://dx.doi.org/10.1164/rccm.201803-0589OC] [PMID: 30576221]
[8]
Rodriguez M, Thille AW, Boissier F, et al. Predictors of successful separation from high-flow nasal oxygen therapy in patients with acute respiratory failure: A retrospective monocenter study. Ann Intensive Care 2019; 9(1): 101.
[http://dx.doi.org/10.1186/s13613-019-0578-8] [PMID: 31511996]
[9]
Mauri T, Carlesso E, Spinelli E, et al. Increasing support by nasal high flow acutely modifies the ROX index in hypoxemic patients: A physiologic study. J Crit Care 2019; 53: 183-5.
[http://dx.doi.org/10.1016/j.jcrc.2019.06.020] [PMID: 31254849]
[10]
Gianstefani A, Farina G, Salvatore V, et al. Role of ROX index in the first assessment of COVID-19 patients in the emergency department. Intern Emerg Med 2021; 16(7): 1959-65.
[http://dx.doi.org/10.1007/s11739-021-02675-2] [PMID: 33646507]
[11]
Duan J, Zeng J, Deng P, et al. High-Flow nasal cannula for COVID-19 patients: A multicenter retrospective study in china. Front Mol Biosci 2021; 8: 639100.
[http://dx.doi.org/10.3389/fmolb.2021.639100] [PMID: 33928119]
[12]
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(6): 909-19.
[http://dx.doi.org/10.4187/respcare.08631] [PMID: 33328179]
[13]
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(1): 693.
[http://dx.doi.org/10.4081/mrm.2020.693] [PMID: 32983456]
[14]
Artacho Ruiz R, Artacho Jurado B, Caballero Güeto F, et al. Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. Med Intensiva 2021; 45(2): 80-7.
[http://dx.doi.org/10.1016/j.medine.2019.07.008] [PMID: 31455561]
[15]
Lee CU, Jo YH, Lee JH, et al. The index of oxygenation to respiratory rate as a prognostic factor for mortality in Sepsis. Am J Emerg Med 2021; 45: 426-32.
[http://dx.doi.org/10.1016/j.ajem.2020.09.052] [PMID: 33039213]
[16]
Cornillon A, Balbo J, Coffinet J, et al. The ROX index as a predictor of standard oxygen therapy outcomes in thoracic trauma. Scand J Trauma Resusc Emerg Med 2021; 29(1): 81.
[http://dx.doi.org/10.1186/s13049-021-00876-4] [PMID: 34154631]
[17]
Zaboli A, Ausserhofer D, Pfeifer N, et al. The ROX index can be a useful tool for the triage evaluation of COVID-19 patients with dyspnoea. J Adv Nurs 2021; 77(8): 3361-9.
[http://dx.doi.org/10.1111/jan.14848] [PMID: 33792953]
[18]
Cable C, Kashiouris M, Gross A, Wiese B. Utility of the respiratory rate-oxygenation (Rox) index in predicting respiratory failure requiring mechanical ventilation in acute care medicine. Chest 2020; 158(4): A576.
[http://dx.doi.org/10.1016/j.chest.2020.08.544]
[19]
Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Adv Respir Med 2021; 89(1): 1-7.
[http://dx.doi.org/10.5603/ARM.a2020.0176] [PMID: 33471350]
[20]
Wettstein RB, Shelledy DC, Peters JI. Delivered oxygen concentrations using low-flow and high-flow nasal cannulas. Respir Care 2005; 50(5): 604-9.
[PMID: 15871753]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy