SpO2/FiO2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure

Kim, Ga Eun; Choi, Sun Ha; Park, Mireu; Jung, Ji Sim; Lee, Myeongjee; Kim, Soo Yeon; Kim, Min Jung; Kim, Yoon Hee; Kim, Kyung Won

doi:10.1038/s41598-021-92893-7

Cited by 8 publications

(12 citation statements)

References 32 publications

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“…The results were consistent with those of a previous study on hypoxic respiratory distress, which presented S/F or ROX as predictive markers for HFNC failure 8,9,11,19–21 . When the AUC of S/F was compared with ROX or ROX‐modified indices in this study, S/F was a better indicator or had a similar diagnostic value, although the index was a simpler form.…”

Section: Discussionsupporting

confidence: 91%

S/F and ROX indices in predicting failure of high‐flow nasal cannula in children

Kim

Suh

Park

2022

Pediatrics International

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Background A high‐flow nasal cannula (HFNC) is a useful respiratory support for children with respiratory distress; however, it elevates the risk of belated intubation. Recently, indices based on percutaneous oxygen saturation, a fraction of inspired oxygen, and respiratory rate (RR) have been suggested for the prediction of HFNC failure. We aimed to evaluate various indices predicting HFNC failure in children who started receiving HFNC at a tertiary center for 27 months. Methods Cases of HFNC failure were classified as hypoxic respiratory failure (HRF) or non‐HRF (NHRF) depending on the cause of intubation. The ratio of percutaneous oxygen saturation to the fraction of inspired oxygen (S/F), the ratio of S/F to RR (ROX), the ratio of S/F to RR/median RR (ROX‐M), and the ratio of S/F to z‐score of RR (ROX‐Z) were calculated and compared between groups. Results Of the 152 cases, 45 (29.6%) failed to wean from the HFNC support, of which 21 (46.7%) were HRFs and 24 (53.3%) were NHRFs. The S/F and ROX‐M at 6 h and 3 h, respectively, predicted HRF well with a high area under the curve. Initial hypercapnia and low weight were good predictors for NHRF. Conclusions For the management of children with HFNC, these risk factors and indicators should be monitored to make an early decision regarding intubation.

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Section: Discussionsupporting

confidence: 91%

S/F and ROX indices in predicting failure of high‐flow nasal cannula in children

Kim

Suh

Park

2022

Pediatrics International

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“…The SpO 2 /FiO 2 (SF) ratio, which correlates with the partial pressure of oxygen PaO 2 /FiO 2 (PF) ratio [ 7 ], can also be utilized as a prognostic marker for acute hypoxemic respiratory failure [ 8 ]. Notably, the SF ratio has been reported as a reliable factor for predicting failure of HFNC [ 9 ] or non-invasive ventilation [ 10 ] in clinical practice when arterial blood gas sampling is not readily available. Moreover, unlike traditional respiratory failure, COVID-19 often presents with silent hypoxia, a condition where the patient has no abnormal respiratory pattern despite severe hypoxia [ 11 ]; therefore, respiratory rate may not be crucial in predicting HFNC failure in COVID-19.…”

Section: Introductionmentioning

confidence: 99%

ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study

et al. 2022

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Background The ratio of oxygen saturation (ROX) index, defined as the ratio of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) to respiratory rate, can help identify patients with hypoxemic respiratory failure at high risk for intubation following high-flow nasal cannula (HFNC) initiation; however, whether it is effective for predicting intubation in coronavirus disease 2019 (COVID-19) patients receiving HFNC remains unknown. Moreover, the SpO2/FiO2 ratio has been assessed as a prognostic marker for acute hypoxemic respiratory failure. This study aimed to determine the utility of the ROX index and the SpO2/FiO2 ratio as predictors of failure in COVID-19 patients who received HFNC. Methods This multicenter study was conducted in seven university-affiliated hospitals in Korea. Data of consecutive hospitalized patients diagnosed with COVID-19 between February 10, 2020 and February 28, 2021 were retrospectively reviewed. We calculated the ROX index and the SpO2/FiO2 ratio at 1 h, 4 h, and 12 h after HFNC initiation. The primary outcome was HFNC failure defined as the need for subsequent intubation despite HFNC application. The receiver operating characteristic curve analysis was used to evaluate discrimination of prediction models for HFNC failure. Results Of 1,565 hospitalized COVID-19 patients, 133 who received HFNC were analyzed. Among them, 63 patients (47.4%) were successfully weaned from HFNC, and 70 (52.6%) were intubated. Among patients with HFNC failure, 32 (45.7%) died. The SpO2/FiO2 ratio at 1 h after HFNC initiation was an important predictor of HFNC failure (AUC 0.762 [0.679–0.846]). The AUCs of SpO2/FiO2 ratio at 4 h and ROX indices at 1 h and 4 h were 0.733 (0.640–0.826), 0.697 (0.597–0.798), and 0.682 (0.583–0.781), respectively. Multivariable analysis showed that the patients aged ≥70 years are 3.4 times more likely to experience HFNC failure than those aged <70 years (HR 3.367 [1.358–8.349], p = 0.009). The SpO2/FiO2 ratio (HR 0.983 [0.972–0.994], p = 0.003) at 1 h was significantly associated with HFNC failure. Conclusions The SpO2/FiO2 ratio following HFNC initiation was an acceptable predictor of HFNC failure. The SpO2/FiO2 ratio may be a good prognostic marker for predicting intubation in COVID-9 patients receiving HFNC.

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“…However, they could not identify the accuracy of the SF ratio nor its cutoff value for outcome prediction. Kim et al [ 14 ] found that SF ratio<230 at initiation of HFNC had an AUC of 0.75 in terms of prediction of HFNC failure, which is better than that of the PF ratio. The univariate analysis revealed that SF ratio<200 at 2 hours was associated with HFNC failure in acute hypoxic respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…pROX is also easily calculated and can be used as bedside parameter. In a similar study, Yildizdas et al (16) calculated the ROX index in pediatric patients by using the respiratory Z score instead of the RR. They found that an ROX index above 66.7 at 24 hours after HFNC had 86%…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress

Saelim¹,

Thirapaleka²,

Ruangnapa³

et al. 2022

Clin Exp Pediatr

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SpO2/FiO2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure

Cited by 8 publications

References 32 publications

S/F and ROX indices in predicting failure of high‐flow nasal cannula in children

S/F and ROX indices in predicting failure of high‐flow nasal cannula in children

ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study

Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress

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