| Popis: |
Background and aim: Delayed intubation and mechanical ventilation are associated with poor outcomes. High Flow Nasal Cannula (HFNC) oxygen therapy is increasingly used with variable success, including COVID-19. Early failure detection is crucial; ROX and modified ROX (mROX) index have been proposed. The present study evaluated the utility and relationship of ROX and mROX indexes in COVID-19 patients started on HFNC oxygen therapy.Methods: the present, prospective, observational pilot study collected data from adult COVID-19 patients admitted to intensive care with acute respiratory failure and requiring HFNC oxygenation from 29 Jan - 29 Jun 2021. Clinico-demographic data related to ROX and mROX was collected and calculated. The patients were divided into two cohorts based on the HFNC therapy success, and ROX and mROX were compared as screening tools for predicting failure. Further, the area under the curve for ROX and mROX was also assessed for mean values and accuracy. Epitools and MedCalc software were used online for different statistical analyses, and p Results: Twenty-seven out of 32 patients during the observation period fulfilled inclusion criteria; 13 (48.15%) of the HFNC oxygenation therapy failed. The majority (74.1%) of the patients were male; the cohort's mean + standard deviation age was 53.93 + 10.67 years. Both mean ROX and mROX at admission and six-hour time-point showed fair-to-good sensitivity and specificity; the accuracies for predicting failure for ROX versus mROX at baseline values 4.78 and 3.98, and six-hour values of 4.5 and 4.05 were 59.81 versus 70.68, and 67.42 versus 74.88 respectively (all p >0.05). Only mROX of 4.05 (mean value) and 3.34 (Youden’s J cut-off) had a sensitivity plus specificity at 1.56 and 1.63 (i.e., 156% and 163%), respectively. The mROX values between HFNC success and failure at baseline and six hours differed significantly. However, the area under the ROC for ROX and mROX at baseline and six hours were statistically indifferent.Conclusion: Both ROX and mROX at baseline and six hours had fair-to-good sensitivity, specificity, positive and negative predictive values, and area under the ROC; the differences were statistically insignificant. The accuracies of the indices were better at six hours than the baseline. Although both the indices can be used, only mROX of 4.05 at six-hour had a sensitivity plus specificity of 156% to be considered a clinically valuable screener.CTRI: CTRI/2021/01/030431 |
