ROX index to predict failure with low flow devices in COVID-19
DOI:
https://doi.org/10.5281/Keywords:
Oxygen Inhalation Therapy, Oximetry, COVID-19Abstract
Background: The ROX index (iROX) obtained from pulse oximetry saturation/inspired fraction of oxygen and respiratory rate, predicts success with high-flow nasal cannula (HFNC), however its performance for low-flow oxygenation devices (DOBF) is unknown.
Objective: To determine suitability of iROX at 12 hours as a predictor of mechanical ventilation (VMI) in hospitalized patients with severe COVID-19 and DOBF.
Material and methods: An historical cohort was performed. Adults with COVID-19, hospitalized, with supplemental oxygen supply are included, excluding patients with pathologies in chronic stages that could alter the results, calculating the iROX at 12 hours, obtaining the cut-off point using a ROC curve and Youden index, the risk of VMI is prolonged using relative risk (RR), with 95% confidence intervals (95%CI). Confounding variables were evaluated to determine the performance of the iROX. The dependent variable mechanical ventilation recorded as reported in the file and the independent iROX obtained in the same way as the previous one.
Results: 63 patients with a median age of 62 years were included. The best iROX cut-off point at 12 hours was 5.35. With this cut-off point, VMI was associated with a RR of 8.75 (95% CI 2.36-32.35). In the multivariate model with an OR of 9.26; (95% CI, 2.39 – 35.78), after initiation of DOBF was consistently associated with an increased risk of intubation.
Conclusion: In hospitalized patients with severe COVID-19, an iROX < 5.35 at 12 hours appears to be a predictor for the onset of VMI.
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References
Vega M, Dongilli R, Olaizola G, Colaianni N, Sayat M, Pisani L, et al. COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU. Pulmonology. 2022;28(1):13-7. doi: 10.1016/j.pulmoe.2021.04.003.
Suliman L, Abdelgawad T, Farrag N, Abdelwahab H. Validity of rox index in prediction of risk of intubation in patients with covid-19 pneumonia. Adv Respir Med. 2021;89(1):1-7. doi: 10.5603/ARM.a2020.0176.
Ochoa H, Martínez I, Díaz J, Greene E. Ventilación mecánica en pacientes con COVID-19 de acuerdo a los fenotipos de Gattinoni. Acta Médica Grupo Ángeles. 2020;18(3):336-40. doi: https://dx.doi.org/10.35366/95421.
Pérez J, Thirión I, Aguirre T, Rodríguez S. ¿Qué tan silenciosa es la hipoxemia en COVID-19? Neumol y Cirugía Tórax. 2020;79:69-70. doi: 10.35366/94629.
Matta A, Chaudhary S, Lo K, De Joy I, Gul F, Torres R. Timing of Intubation and Its Implications on Outcomes in Critically Ill Patients With Coronavirus Disease 2019 Infection. Crit Care Explor. 2020;2(10):e0262. doi: 10.1097/ CCE.0000000000000262.
Flores A, Torres X, Llausás E, Pérez G. Protocolo de Atención para pacientes con sospecha o confirmación de SARS CoV2 Sinaloa. Secretaría salud. 2020. Disponible en: http://saludsinaloa.gob.mx/wp-content/uploads/2020/ files/Protocolo%20de%20Atencioìn%20SARS%20CoV2%20 Sinaloa%20Anexo%201%20v.1.1%2012%2005%202020.pdf.
Dulcey L, Castillo J, Theran J, Caltagirone R, Aguas M. Utilidad del índice ROX como predictor de fallo respiratorio, mortalidad y complicaciones en pacientes con COVID-19 sin soporte ventilatorio invasivo, estudiounicéntrico. Rev Med Clínica. 2022;22. doi: 10.5281/zenodo.6949776.
Zakaria A, Levy N, Charpentier J, Mira J, Jamme M, Jozwiak M. Use of high-flow nasal cannula oxygen and risk factors for high-flow nasal cannula oxygen failure in critically-ill patients with COVID-19. Respiratory Research. 2022; 23:329. doi: 10.1186/s12931-022-02231-2.
García L, Ramos V, Tornero M, Lluna A, Velasco S, Parra J. Benefits of early use of high-flow-nasal-cannula (HFNC) in patients with COVID-19 associated pneumonia. Med Clin (Barc). 2022;158(11):540-2. doi: 10.1016/j.medcli.2021.05.015.
Prakash J, Bhattacharya P, Yadav A, Kumar A, Tudu L, Prasad K. ROX index as a good predictor of high flow nasal cannula failure in COVID-19 patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis. J Crit Care. 2021;66:102-8. doi: 10.1016/j.jcrc.2021.08.012.
Prower E, Grant D, Bisquera A, Breen C, Camporota L, Gavrilovski M. The ROX index has greater predictive validity than NEWS2 for deterioration in Covid-19. E Clinical Medicine. 2021;35. doi: 10.1016/j.eclinm.2021.100828.
Hernández G, Roca O, Colinas L. High-flow nasal cannula support therapy: New insights and improving performance. Crit Care. 2017;21(1):62. doi: 10.1186/s13054-017-1640-2.
Talavera J, Rivas R. Del juicio clínico al diseño de cohorte. Rev Med Inst Mex Seguro Soc. 2012; 50(4):383-8. Disponible en: https://www.medigraphic.com/pdfs/imss/im-2012/im124i.pdf.
Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad. Lineamiento para la atención de pacientes por COVID-19. Secretaría de Salud. 2020. Disponible en: https://coronavirus.gob.mx/wp-content/uploads/2020/04/Lineamiento_Clinico_COVID-19_ CCINSHAE_14022020.pdf.
Instituto Mexicano del Seguro Social. Material de apoyo para equipos de respuesta COVID-19. Educación en Salud. 2020;47. Disponible en: http://educacionensalud.imss.gob.mx/es/system/files/Material_de_apoyo_COVID-19.pdf.
Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernández G. 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. doi: 10.1164/ rccm.201803-0589OC.
Talavera J, Rivas R, Palacios L, Bernal L. Tamaño de muestra. Rev Med Inst Mex Seguro Soc. 2011;49(5):517-22. Disponible en: https://www.medigraphic.com/pdfs/imss/im2011/im115i.pdf.
Roca O, Messika J, Caralt B, García M, Sztrymf B, Ricard J. 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. doi:10.1016/j. jcrc.2016.05.022.
Talavera J, Rivas R. Pertinencia de la prueba estadística. Rev Med Inst Mex Seguro Soc. 2011;49(4):401-5. Disponible en: https://www.medigraphic.com/pdfs/imss/im-2011/im114j. pdf.
Rivas R, Moreno J, Talavera J. Diferencias de medianas con la U de Mann-Whitney. Rev Med Inst Mex Seguro Soc. 2013; 51(4):414-9. Disponible en: https://www.medigraphic.com/pdfs/imss/im-2013/im134k.pdf.
Rivas R, Castelán O, Pérez M, Talavera J. Prueba X2, de lo esperado a lo observado. Rev Med Inst Mex Seguro Soc. 2013;51(5):552-7. Disponible en: https://www.medigraphic. com/pdfs/imss/im-2013/im135j.pdf.
Berea R, Rivas R, Pérez M, Palacios L, Moreno J, Talavera J. Del juicio clínico a la regresión logística múltiple. Rev Med Inst Mex Seguro Soc. 2014;52(2):192-7. Disponible en: https:// www.medigraphic.com/pdfs/imss/im-2014/im142r.pdf.
Montiel G, Toledo A, Castro-Sayat M, Herrera F. Rol de la cánula nasal de alto-flujo en contexto del COVID-19: revisión clínica. 2021;13:157-203. Disponible en: https://alatorax.org/es/publicaciones/respirar/36/rol-de-la-canula-nasal-de-alto-flujo-en-contexto-del-covid-19-revision-clinica.
Leszek A, Wozniak H, Giudicelli A, Suh N, Boroli F, Pugin. Early Measurement of ROX Index in Intermediary Care Unit Is Associated with Mortality in Intubated COVID-19 Patients: A Retrospective Study. J Clin Med. 2022;11(2):365. doi:10.3390/ jcm11020365.
Tobin M, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care. 2020;10(1):4-6. doi: 10.1186/s13613-020-00692-6.
Hu M, Zhou Q, Zheng R, Li X, Ling J, Chen Y. Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study. BMC Pulm Med. 2020;20(1). doi: 10.1186/s12890-020-01354-w.
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