Validation Clinical Trial
Official title:
Prospective Validation of the ROX Index Utility in Predicting Failure of HFNC Treatment in Patients With Acute Respiratory Failure
We recently described the ROX index, defined as the ratio of SpO2/FIO2 to respiratory rate that outperformed the diagnostic accuracy of the two variables separately. Patients who had a ROX index ≥4.88 after 12 hours of HFNC therapy were less likely to be intubated, even after adjusting for potential covariates. Like any other scoring system, an independent validation of the score in a different population is necessary. We therefore undertook a multicenter, prospective study to validate the ROX index's diagnostic accuracy for determining which patients will fail on HFNC and will need to be intubated.
A growing interest in the non-invasive management of acute respiratory failure has been
fuelled by the advent of high-flow nasal canula oxygen therapy (HFNC) and recent data showing
that use of HFNC was associated with lower mortality, more ventilator-free days and lower
risk for intubation in subsets of patients with PaO2/FIO2≤200mmHg or in those who were
immunocompromised in comparison with non-invasive ventilation or standard oxygen. These
positive results in favour of HFNC followed physiological studies indicating oxygenation and
comfort improvements associated with HFNC use. This has led clinicians to try this technique
in the most severe respiratory failure patients, those with ARDS.
Consubstantial to the increasing use of HFNC is the risk of delaying intubation. This is a
major concern since a large body of evidence has shown that patients that fail non-invasive
ventilatory management of de novo acute respiratory failure (ARF) have a worse outcome.
The variability in both the decision to intubate and its timing reported in several studies
suggest that clinical parameters such as respiratory parameters alone are not sufficient and
that the progression of the respiratory failure is not sufficiently taken into account. To
address this need, we investigated a new score to identify patients at risk of intubation to
help clinicians, with three goals simple to use, accurate, and immediately performable at the
patients' bedside by any staff.
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