Comparison of Modified ROX Index Score and ROX Index Score for Early Prediction of High Flow Nasal Oxygen Therapy Outcome in Patients with Acute Respiratory Failure: A Prospective Observational Cohort Study
Keywords :
Acute hypoxemic respiratory failure, High flow nasal oxygen, Hypoxia, Intensive care, Non-invasive ventilation
Citation Information :
Sarkar AG, Sharma A, Kothari N, Goyal S, Meshram T, Kumari K, Mohammed S, Bhatia P. Comparison of Modified ROX Index Score and ROX Index Score for Early Prediction of High Flow Nasal Oxygen Therapy Outcome in Patients with Acute Respiratory Failure: A Prospective Observational Cohort Study. Indian J Crit Care Med 2024; 28 (9):842-846.
Background: We compared the modified ROX index and ROX index scores in earlier predictions of high-flow nasal oxygen (HFNO) therapy outcomes in patients with acute respiratory failure.
Methods: We conducted a prospective observational study on 151 acute respiratory failure patients initiated on HFNO therapy. The primary objective of this research was to compare the modified ROX index and ROX index to investigate which score predicted HFNO treatment outcome earlier.
Results: The modified ROX index score had better predictive power than the ROX score at different time points, especially one hour following the start of HFNO therapy (AUC 0.790; 95% CI: 0.717–0.863; p < 0.001). For the ROX Index at 1 hour, the ideal cut-off value for HFNO outcome was 4.36 (sensitivity: 72.6%, specificity: 53.9%), and for the modified ROX index at 1 hour, it was 4.63 (sensitivity: 74.2%, specificity: 69.7%). The presence of various comorbidities didn't show any change in ROX-HR cut-off values.
Conclusion: The modified ROX index is a better predictor of the success of HFNO therapy than the ROX index. Furthermore, the presence of any comorbidities did not affect modified ROX index cut-off values or the outcome of HFNO therapy.
Mishra S, Kothari N, Sharma A, Goyal S, Rathod D, Meshram T, et al. Comparison of oxygen delivery devices in postoperative patients with hypoxemia: An open-labeled randomized controlled study. Indian J Crit Care Med 2024;28(3):294–298. DOI: 10.5005/jp-journals-10071-24659.
Roy A, Khanna P, Chowdhury SR, Haritha D, Sarkar S. The impact of high-flow nasal cannula vs other oxygen delivery devices during bronchoscopy under sedation: A systematic review and meta-analyses. Indian J Crit Care Med 2022;26(10):1131–1140. DOI: 10.5005/jp-journals-10071-24339.
Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015;372(23):2185–2196. DOI: 10.1056/NEJMoa1503326.
Goh KJ, Chai HZ, Ong TH, Sewa DW, Phua GC, Tan QL. Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate. J Intensive Care 2020;8:41. DOI: 10.1186/s40560-020-00458-z.
Mauri T, Carlesso E, Spinelli E, Turrini C, Corte FD, Russo R, et al. Increasing support by nasal high flow acutely modifies the ROX index in hypoxemic patients: A physiologic study. J Crit Care 2019;53:183–185. DOI: 10.1016/j.jcrc.2019.06.020.
Panzuti G, Vega ML, Polastri M. Respiratory rate-OXygenation index: Enhancing decision-making and predicting rehabilitative outcomes in critical respiratory settings. Int J Ther Rehab 2021;28(4):1–4. DOI: 10.12968/ijtr.2021.0034.
Ahn S, Park J, Song J, Kim J, Cho H, Moon S. Association of ROX index with mechanical ventilator use in sepsis patients in the emergency department. J Clin Med 2022;11(2):342. DOI: 10.3390/jcm11020342.
Roca O, Messika J, Caralt B, García-de-Acilu M, Sztrymf B, Ricard JD, 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;35:200–205. DOI: 10.1016/j.jcrc.2016.05.022.
Kansal A, Ong WJD, Dhanvijay S, Siosana ATP, Padillo LM, Tan CK, et al. Comparison of ROX index (SpO2/FIO2 ratio/respiratory rate) with a modified dynamic index incorporating PaO2/FIO2 ratio and heart rate to predict high flow nasal cannula outcomes among patients with acute respiratory failure: A single centre retrospective study. BMC Pulm Med 2022;22(1):350. DOI: 10.1186/s12890-022-02121-9.
Li Z, Chen C, Tan Z, Yao Y, Xing S, Li Y, et al. Prediction of high-flow nasal cannula outcomes at the early phase using the modified respiratory rate oxygenation index. BMC Pulm Med 2022;22(1):227. DOI: 10.1186/s12890-022-02017-8.
Webb LV, Chahine R, Aban I, Prabhakaran P, Loberger JM. Predicting high-flow nasal cannula therapy outcomes using the ROX-HR index in the pediatric ICU. Respir Care 2022:respcare.09765. DOI: 10.4187/respcare.09765.
Karim HMR, Esquinas AM. Success or failure of high-flow nasal oxygen therapy: The ROX index is good, but a modified ROX index may be better. Am J Respir Crit Care Med 2019;200(1):116-117. DOI: 10.1164/rccm.201902-0419LE.
Ceylan İ, Sayan HE, Ökmen K, Öylevi U. The role of ROX and mROX indices in predicting intubation in COVID 19 patients treated with high flow nasal oxygen in Intensive Care Unit. J Clin Med Kaz 2021;18(3):18–22. DOI: 10.23950/jcmk/10932.
