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Abstract
Background
The ratio of SpO2/FiO2 to respiratory rate (ROX) index is commonly used to predict the failure of high-flow nasal cannula. However, its predictive power for noninvasive ventilation (NIV) failure is unclear.
Methods
This was a secondary analysis of a multicenter prospective observational study, intended to update risk scoring. Patients with de novo acute respiratory failure were enrolled, but hypercapnic patients were excluded. The ROX index was calculated before treatment and after 1–2, 12, and 24 h NIV. Differences in predictive power for NIV failure using the ROX index, PaO2/FiO2, and PaO2/FiO2/respiratory rate were tested.
Results
A total of 1286 patients with de novo acute respiratory failure were enrolled. Of these, 568 (44%) experienced NIV failure. Patients with NIV failure had a lower ROX index than those with NIV success. The rates of NIV failure were 92.3%, 70.5%, 55.3%, 41.1%, 35.1%, and 29.5% in patients with ROX index values calculated before NIV of ≤ 2, 2–4, 4–6, 6–8, 8–10, and > 10, respectively. Similar results were found when the ROX index was assessed after 1–2, 12, and 24 h NIV. The area under the receiver operating characteristics curve was 0.64 (95% CI 0.61–0.67) when the ROX index was used to predict NIV failure before NIV. It increased to 0.71 (95% CI 0.68–0.74), 0.74 (0.71–0.77), and 0.77 (0.74–0.80) after 1–2, 12, and 24 h NIV, respectively. The predictive power for NIV failure was similar for the ROX index and for the PaO2/FiO2. Likewise, no difference was found between the ROX index and the PaO2/FiO2/respiratory rate, except at the time point of 1–2 h NIV.
Conclusions
The ROX index has moderate predictive power for NIV failure in patients with de novo acute respiratory failure.
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Details
1 The First Affiliated Hospital of Chongqing Medical University, Department of Respiratory and Critical Care Medicine, Chongqing, China (GRID:grid.452206.7) (ISNI:0000 0004 1758 417X)
2 The Chongqing Western Hospital, Department of Respiratory and Critical Care Medicine, Chongqing, China (GRID:grid.452206.7)
3 Yongchuan Hospital of Chongqing Medical University, Department of Critical Care Medicine, Chongqing, China (GRID:grid.203458.8) (ISNI:0000 0000 8653 0555)
4 The Second Affiliated Hospital of Chongqing Medical University, Department of Respiratory and Critical Care Medicine, Chongqing, China (GRID:grid.412461.4) (ISNI:0000 0004 9334 6536)
5 University of Electronic Science and Technology of China, Department of ICU, Sichuan Provincial People’s Hospital, Chengdu, China (GRID:grid.54549.39) (ISNI:0000 0004 0369 4060)