Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index

High-flow nasal cannula support therapy: new insights and improving performance

“…In the subgroup of patients with a PaO 2 /F i O 2  ≤ 200 mmHg, the intubation rate was significantly lower in the HFNC groupRello et al [31]Retrospective cohort35 patients with ARF due to H1N1 viral pneumoniaAfter 6 h of HFNC, non‐responders had a lower PaO 2 /F i O 2 . All 8 patients on vasopressors required intubationLemiale et al [29]Randomized controlled trial100 immunocompromised patients with ARF randomized to a 2 h of HFNC vs conventional oxygenNo differences in NIV or invasive MV during the 2 h period were observed.No differences in secondary outcomes (RR, HR, comfort, dyspnea and thirst) were observedMokart et al [42]Retrospective propensity‐score analysis178 cancer patients admitted to the ICU due to severe ARFHFNC‐NIV was associated with more VFD and less septic shock occurrence.Mortality of patients treated with HFNC 35 vs 57% for patients never treated with HFNC, p  = 0.008Kang et al [30]Retrospective cohort175 patients who failed on HFNC and required intubationIn propensity‐adjusted and ‐matched analysis, early intubation (<48 h) was associated with better overall ICU mortality [adjusted OR = 0.317, p  = 0.005; matched OR = 0.369, p  = 0.046]Frat et al [23]Post‐hoc analysis of a randomized controlled trial82 immunocompromised patients of the FLORALI studyNIV was associated with higher risk of intubation and mortalityRoca et al [32]Prospective cohort157 patients with severe pneumoniaROX index, defined as ratio of SpO 2 /F i O 2 to respiratory rate, ≥ 4.88 measured after 12 h of HFNC was significantly associated with lower risk for MV (HR 0.273 [95% CI 0.121–0.618])Coudroy et al [25]Retrospective cohort115 immunocompromised patientsThe rates of intubation and 28‐day mortality were significantly higher in patients treated with NIV than with HFNCCardiac surgeryParke et al [18]Randomized60 patients with non‐severe hypoxemic ARF were randomized to receive HFNC or oxygen therapyHFNC patients tended to need NIV less frequently (10 vs 30%; p  = 0.10) and had significantly fewer desaturations ( p  = 0.009)Parke et al [38]Randomized controlled trial340 patients after cardiac surgery randomized to HFNC vs conventional oxygen therapy for 48 hNo differences in oxygenation on Day 3 after surgery were observed, but HFNC did reduce the requirement for escalation of respiratory support (OR 0.47, 95% CI 0.29–0.7, p  = 0.001)Corley et al [39]Randomized controlled trial155 extubated patients with BMI ≥ 30 kg/m 2 received conventional oxygen therapy or HFNCNo difference was seen between groups in atelectasis. There was no difference in mean PaO 2 /F i O 2 ratio or RR.…”

“…Similarly, in a series of 20 patients with H 1 N 1 infection treated with HFNC, worse PaO 2 /FiO 2 ratios were observed in patients who required intubation after six hours of treatment [31]. Interestingly, a recent prospective study showed that patients with severe pneumonia who had a ROX index (defined as the ratio of SpO 2 /FiO 2 to respiratory rate) ≥ 4.88 after 12 h of HFNC therapy were less likely to be intubated, even after adjusting for potential covariates [32]. Moreover, among patients who were still on HFNC after 18 h, the median change in the ROX index between 18 and 12 h was significantly higher in patients who did not require intubation.…”

“…In fact, most patients included in studies have bilateral infiltrates [20, 32]. The Berlin definition of ARDS [34] requires a minimum of 5 cmH 2 O of PEEP, and it has been shown that HFNC can provide a level of PEEP that is higher at peak expiratory pressure [7].…”

High-Flow Nasal Cannula Support Therapy: New Insights and Improving Performance

“…Similarly, in a series of 20 patients with H 1 N 1 infection treated with HFNC, worse PaO 2 /FiO 2 ratios were observed in patients who required intubation after six hours of treatment [31]. Interestingly, a recent prospective study showed that patients with severe pneumonia who had a ROX index (defined as the ratio of SpO 2 /FiO 2 to respiratory rate) ≥ 4.88 after 12 h of HFNC therapy were less likely to be intubated, even after adjusting for potential covariates [32]. Moreover, among patients who were still on HFNC after 18 h, the median change in the ROX index between 18 and 12 h was significantly higher in patients who did not require intubation.…”

“…In fact, most patients included in studies have bilateral infiltrates [20,32]. The Berlin definition of ARDS [34] requires a minimum of 5 cmH 2 O of PEEP, and it has been shown that HFNC can provide a level of PEEP that is higher at peak expiratory pressure [7].…”