An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy
An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy
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DOI：
10.1164/rccm.201803-0589oc
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发表时间：
2019-06-01
影响因子：
24.7
通讯作者：
Ricard, Jean-Damien
中科院分区：
文献类型：
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作者：
Roca, Oriol;Caralt, Berta;Ricard, Jean-Damien
基本原理：在急性低氧性呼吸衰竭患者的高流量鼻插管（HFNC）治疗过程中，一个重要的关注点是不要延迟插管。（称为ROX，定义为脉搏血氧饱和度/FIO 2测量的氧饱和度与呼吸率的比值），用于确定HFNC结果方法：这是一项为期2年的多中心前瞻性观察性队列研究，包括接受HFNC治疗的肺炎患者。通过ROX与HFNC结局相关性的考克斯比例风险模型进行识别。最具体的截止ROX指数预测HFNC失败和成功assessed. Measures和主要结果：在191例患者治疗HFNC的验证队列，68（35.6%）需要插管。ROX指数的预测准确性随时间增加（受试者工作特征曲线下的面积：2小时，0.679; 6小时，0.703; 12小时，0.759）。ROX大于或等于4.88，在2（风险比，0.434; 95%置信区间，0.264-0.715; P = 0.001），6（风险比，0.304; 95%置信区间，0.182-0.509; P < 0.001）或12小时（风险比，0.291; 95%置信区间，0.161-0.524; P < 0.001）开始HFNC后，与插管风险降低一致相关。在HFNC开始的2、6和12小时，ROX分别小于2.85、小于3.47和小于3.85是HFNC失败的预测因子。失败的患者在12小时内的ROX指数值增加较低。在该指数的组成部分，血氧饱和度测量脉搏血氧饱和度/FIO 2，有一个更大的权重比呼吸rate.Conclusions：在肺炎与HFNC治疗急性呼吸衰竭的患者，ROX是一个指数，可以帮助确定那些患者低，高风险插管。
Rationale: One important concern during high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemic respiratory failure is to not delay intubation.Objectives: To validate the diagnostic accuracy of an index (termed ROX and defined as the ratio of oxygen saturation as measured by pulse oximetry/FIO2, to respiratory rate) for determining HFNC outcome (need or not for intubation).Methods: This was a 2-year multicenter prospective observational cohort study including patients with pneumonia treated with HFNC. Identification was through Cox proportional hazards modeling of ROX association with HFNC outcome. The most specific cutoff of the ROX index to predict HFNC failure and success was assessed.Measurements and Main Results: Among the 191 patients treated with HFNC in the validation cohort, 68 (35.6%) required intubation. The prediction accuracy of the ROX index increased over time (area under the receiver operating characteristic curve: 2 h, 0.679; 6 h, 0.703; 12 h, 0.759). ROX greater than or equal to 4.88 measured at 2 (hazard ratio, 0.434; 95% confidence interval, 0.264-0.715; P = 0.001), 6 (hazard ratio, 0.304; 95% confidence interval, 0.182-0.509; P < 0.001), or 12 hours (hazard ratio, 0.291; 95% confidence interval, 0.161-0.524; P < 0.001) after HFNC initiation was consistently associated with a lower risk for intubation. A ROX less than 2.85, less than 3.47, and less than 3.85 at 2, 6, and 12 hours of HFNC initiation, respectively, were predictors of HFNC failure. Patients who failed presented a lower increase in the values of the ROX index over the 12 hours. Among components of the index, oxygen saturation as measured by pulse oximetry/FIO2, had a greater weight than respiratory rate.Conclusions: In patients with pneumonia with acute respiratory failure treated with HFNC, ROX is an index that can help identify those patients with low and those with high risk for intubation.