Accepted for/Published in: JMIRx Med
Date Submitted: Mar 24, 2021
Open Peer Review Period: Mar 24, 2021 - May 19, 2021
Date Accepted: Jun 4, 2021
Date Submitted to PubMed: Aug 4, 2023
(closed for review but you can still tweet)
Utility of ROX Index in predicting Intubation for COVID-19 Patients with Hypoxemic Respiratory Failure Receiving High Flow Nasal Therapy: A Retrospective Study.
ABSTRACT
Background:
Use of high flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concern for increased healthcare worker transmission and delays in invasive mechanical Ventilation (IMV). Herein we analyze the utility of the noninvasive ROX index to predict the need and timing for IMV.
Objective:
Can ROX index be used to predict the need for intubation in patients with COVID-19 related Hypoxemic Respiratory Failure receiving High flow Nasal Therapy?
Methods:
Design This was a retrospective cohort analysis of 129 consecutive patients with COVID-19 admitted to Temple University Hospital in Philadelphia, Pennsylvania, from March 10, 2020, to May 17, 2020. Setting The study was a single center study conducted in COVID units (ICU and floors) at Temple University Hospital Participants Patients with moderate to severe hypoxemic respiratory failure treated with High Flow nasal therapy (HFNT) were included in the study. HFNT patients were divided into two groups: HFNT only and HFNT progressed to IMV. Primary outcomes The primary outcome was the ability of the ROX index to predict the need of IMV. Secondary outcomes were mortality, rates of intubation, length of stay (LOS) and rates of nosocomial infections in our cohort treated with HFNT were also reported.
Results:
Of the 837 patients with COVID-19, 129 met inclusion criteria. The mean age was 60.8 (+13.6) years, BMI 32.6 (+8), 58 (45 %) were female, 72 (55.8%) were African American, 40 (31%) Hispanic. 48 (37.2%) were smokers. Mean time to intubation was 2.5 days (+ 3.3). ROX index of less than 5 at HFNT initiation was predictive of progression to IMV (OR = 2.137, p = 0,052). Any decrease in ROX index after HFNT initiation was predictive of intubation (OR= 14.67, p <0.0001). Mortality was 11.2% in HFNT only group versus 47.5% in the HFNT progressed to IMV group (p,0.0001). Mortality and need for pulmonary vasodilators were higher in the HNFT progressed to IMV group.
Conclusions:
ROX helps predicts need for IMV and thus limiting morbidity and mortality associated with IMV. Clinical Trial: NA
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