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Annals of Intensive Care

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Open Access 01-12-2022 | Research

Prediction of noninvasive ventilation failure using the ROX index in patients with de novo acute respiratory failure

Authors: Jun Duan, Juhua Yang, Lei Jiang, Linfu Bai, Wenhui Hu, Weiwei Shu, Ke Wang, Fuxun Yang

Published in: Annals of Intensive Care | Issue 1/2022

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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Title: Prediction of noninvasive ventilation failure using the ROX index in patients with de novo acute respiratory failure
Authors: Jun Duan
Juhua Yang
Lei Jiang
Linfu Bai
Wenhui Hu
Weiwei Shu
Ke Wang
Fuxun Yang
Publication date: 01-12-2022
Publisher: Springer International Publishing
Published in: Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-022-01085-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prediction of noninvasive ventilation failure using the ROX index in patients with de novo acute respiratory failure

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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