Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia.

Autor: Ruchiwit P; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Thammasat University, Klongluang, Pathum Thani, Thailand., Madua J; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Thammasat University, Klongluang, Pathum Thani, Thailand., Saiphoklang N; Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Thammasat University, Klongluang, Pathum Thani, Thailand.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Feb 15; Vol. 19 (2), pp. e0297624. Date of Electronic Publication: 2024 Feb 15 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0297624
Abstrakt: Background: High-flow nasal cannula (HFNC) therapy is commonly used to treat acute respiratory failure in patients with COVID-19 pneumonia. However, predictors of successful weaning from HFNC in these patients has not been investigated.
Objective: To assess predictors of successful separation from HFNC in patients with COVID-19 pneumonia.
Methods: We conducted a retrospective cohort study at a university hospital in Thailand. Patients with COVID-19 pneumonia requiring HFNC therapy between April 2020 and June 2022 were included. ROX index was defined as the ratio of oxygen saturation (SpO2) / fraction of inspired oxygen (FiO2) to respiratory rate. Heart-ROX (HROX) index was defined as ROX multiplied by heart rate (HR) improvement. HR improvement (delta-HR) was defined as a percentage of the difference between the baseline HR and the morning HR at HFNC weaning day 1 divided by the baseline HR. Weaning success was defined as ability to sustain spontaneous breathing after separation from HFNC without any invasive or non-invasive ventilatory support for ≥48 hours or death.
Results: A total of 164 patients (54% male) were included. Mean age was 61.1±16.1 years. Baseline SpO2/FiO2 was 265.3±110.8. HFNC weaning success was 77.4%. The best cut-off value of ROX index to predict HFNC weaning success was 7.88 with 100% sensitivity, 97.3% specificity, and area under the ROC curve (AUC) of 0.98 (95% CI: 0.937-1.000, p<0.001). The best cut-off value of delta-HR 3.7 with 88.2% sensitivity, 75.7% specificity, and AUC of 0.83 (95% CI: 0.748-0.919, p<0.001). The best cut-off value of HROX index was 59.2 with 88.2% sensitivity, 81.1% specificity, and AUC of 0.89, (95% CI: 0.835-0.953, p<0.001).
Conclusions: The ROX index has the highest accuracy for predicting successful weaning off HFNC treatment in patients with COVID-19 pneumonia. While HROX and delta-HR indices can serve as alternative tools, it is recommended to verify these indices and determine the optimal cut-off value for determining separation from HFNC therapy through a large prospective cohort study.
Trial Registration: Clinicaltrials.in.th number: TCTR20221108004.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Ruchiwit et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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