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Background <p>Incorporation of heart rate, flow rate, and PaO<sub>2</sub>/FIO<sub>2</sub> (PF) ratio to ROX index has been postulated to better predict high-flow nasal cannula (HFNC) usage outcomes in post-extubation setting. Therefore, we aimed to compare ROX index with new modified indices to predict HFNC outcomes in the post-extubation setting.</p> Methods <p>This single-centre 6-year retrospective study included subjects initiated on HFNC post-extubation. The modified indices (ROX-HR, ROX-HR-Flow and POX-HR-Flow) incorporated HFNC flow rate, heart rate and substituted PF ratio for SF ratio. Evaluation was performed using AUROC and cut-offs assessed for prediction of HFNC outcomes.</p> Results <p>Eighty-one subjects were initiated on HFNC post-extubation, of whom 67 patients (82.7%) had HFNC success. ROX-HR-Flow at 2&#xa0;h post-HFNC initiation demonstrated the best prediction accuracy (AUROC 0.854, 95% CI 0.756–0.952). A ROX-HR-Flow &gt; 12.25 at 2&#xa0;h post-HFNC initiation was significantly associated with a lower risk of HFNC failure (Sensitivity 77.6% and Specificity 85.7%).</p> Conclusions <p>Our proposed modified index at 2&#xa0;h post-HFNC initiation (ROX-HR-Flow), may facilitate early and accurate prediction of HFNC outcomes compared to ROX index among subjects initiated on HFNC in the post-extubation setting.</p>

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Comparison of ROX index with modified indices incorporating heart rate, flow rate, and PaO2/FiO2 ratio for early prediction of outcomes among patients initiated on post-extubation high-flow nasal cannula therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月14日

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  • Smitesh Gutta,
  • Wei Jun Dan Ong,
  • Shanaz Matthew Sajeed,
  • Belinda Zer Hui Chern,
  • Monika Gulati Kansal,
  • Faheem Ahmed Khan,
  • Amit Kansal

摘要

Background

Incorporation of heart rate, flow rate, and PaO2/FIO2 (PF) ratio to ROX index has been postulated to better predict high-flow nasal cannula (HFNC) usage outcomes in post-extubation setting. Therefore, we aimed to compare ROX index with new modified indices to predict HFNC outcomes in the post-extubation setting.

Methods

This single-centre 6-year retrospective study included subjects initiated on HFNC post-extubation. The modified indices (ROX-HR, ROX-HR-Flow and POX-HR-Flow) incorporated HFNC flow rate, heart rate and substituted PF ratio for SF ratio. Evaluation was performed using AUROC and cut-offs assessed for prediction of HFNC outcomes.

Results

Eighty-one subjects were initiated on HFNC post-extubation, of whom 67 patients (82.7%) had HFNC success. ROX-HR-Flow at 2 h post-HFNC initiation demonstrated the best prediction accuracy (AUROC 0.854, 95% CI 0.756–0.952). A ROX-HR-Flow > 12.25 at 2 h post-HFNC initiation was significantly associated with a lower risk of HFNC failure (Sensitivity 77.6% and Specificity 85.7%).

Conclusions

Our proposed modified index at 2 h post-HFNC initiation (ROX-HR-Flow), may facilitate early and accurate prediction of HFNC outcomes compared to ROX index among subjects initiated on HFNC in the post-extubation setting.