The ROX index as a predictor of standard oxygen therapy outcomes in thoracic trauma

Abstract

Background Thoracic trauma is commonplace and accounts for 50–70% of the injuries found in severe trauma. Little information is available in the literature as to timing of endotracheal intubation. The main objective of this study was to assess the accuracy of the ROX index in predicting successful standard oxygen (SO) therapy outcomes, and in pre-empting intubation. Methods Patient selection included all thoracic trauma patients treated with standard oxygen who were admitted to a Level I trauma center between January 1, 2013 and April 30, 2020. Successful standard SO outcomes were defined as non-requirement of invasive mechanical ventilation within the 7 first days after thoracic trauma. Results One hundred seventy one patients were studied, 49 of whom required endotracheal intubation for acute respiratory distress (28.6%). A ROX index score ≤ 12.85 yielded an area under the ROC curve of 0.88 with a 95% CI [0.80–0.94], 81.63sensitivity, 95%CI [0.69–0.91] and 88.52 specificity, 95%CI [0.82–0.94] involving a Youden index of 0.70. Patients with a median ROX index greater than 12.85 within the initial 24 h were less likely to require mechanical ventilation within the initial 7 days of thoracic trauma. Conclusion We have shown that a ROX index greater than 12.85 at 24 h was linked to successful standard oxygen therapy outcomes in critical thoracic trauma patients. It is our belief that an early low ROX index in the initial phase of trauma should heighten vigilance on the part of the attending intensivist, who has a duty to optimize management.

impact of calculating ROX index in delaying intubation with COVID-19 patients at King Abdullah medical city

“…High flow nasal cannula (HFNC) is an essential treatment for patients with ARF (acute respiratory failure), which is also a key symptom of Covid-19, and as Ferrer et al (2021) explains, the ROX index (Respiratory Organ Dysfunction Index) is used to predict the success of HFNC in Covid 19 patients. ROX is described as the ratio of FIO2 and SpO2 to respiratory rate (Cornillon et al, 2021;Cysneiros et al, 2020). HFNC is a respiratory mask that covers the nose like an oxygen mask, with the addition of nasal prongs to deliver extra oxygen.…”

Retrospective evaluation of the respiratory rate–oxygenation index to predict the outcome of high‐flow nasal cannula oxygen therapy in dogs (2018–2021): 81 cases

“…1,2 Therefore, accurate and early predictors of the outcome of HFNC use are of special interest in human respiratory medicine. 1,2,17,18 The respiratory rate-oxygenation index (ROX) was originally developed to predict the need for MV in human patients with AHRF receiving HFNC. 1 The index is defined as the ratio of pulse oximetry saturation (SpO 2 )/FiO 2 (SF) to the respiratory rate (RR).…”

“…Since then, the ROX has been shown to be a useful tool to predict HFNC success or failure in patients with pneumonia, coronavirus disease 2019, thoracic trauma, and those in an immunocompromised state. 15,17,18 After validation of the ROX, the modified ROX index (ROX-HR) was created to further improve the predictive value of the ROX by incorporating an additional vital parameter. The ROX-HR incorporates heart rate (HR) into the equation and is defined as the ROX divided by HR multiplied by a factor of 100.…”

The ROX index: “Propelled” by high-flow nasal cannula therapy during the COVID-19 pandemic into greater applicability in respiratory support

“…The index has also shown to be effective in predicting the successful use of noninvasive oxygen therapy (via standard oxygen therapy, HFNC or noninvasive ventilation) and, therefore, not requiring mechanical ventilation in thoracic trauma patients. A median ROX index of ≥ 12.85 in the first 24 h after the initiation of noninvasive oxygen therapy was a successful predictor of not requiring mechanical ventilation for the next seven days after thoracic trauma [ 31 ].…”

“…First, a variety of pathologies have been assessed using the ROX index, including sepsis [ 29 ], COVID-19, acute respiratory failure and pneumonia [ 19 ]. Second, different types of noninvasive oxygen therapy have been studied, including HFNC [ 32 ] and conventional oxygen therapy [ 31 ]. Third, a lack of regularity regarding measurement intervals has been reported, such as the first 6 h of therapy, the first 6 to 12 h [ 32 ], and the first day of admission [ 24 ].…”