Recent research shows that the ROX index can reliably predict treatment outcomes for patients with acute hypoxic respiratory failure (AHRF) receiving oxygen through a high-flow nasal cannula (HFNC) when measured within 12 hours. This includes patients with COVID-19 and pneumonia. The study was presented at the CHEST Annual Meeting in Boston, Massachusetts.
“HFNC is a comfortable way to provide oxygen to patients with respiratory distress. The ROX index may be useful in predicting the successful weaning of hypoxic patients off HFNC,” wrote the authors, led by Inban Pugazhendi. They conducted a literature review and meta-analysis to assess the tool’s ability to predict outcomes in patients with AHRF.
Following PRISMA guidelines, the authors queried PubMed, Embase, Web of Science, and Cochrane Library databases for studies involving use of the ROX index to predict HFNC outcomes in adult patients with AHRF. Studies were excluded if they had fewer than 30 participants, involved pediatric patients, or were case reports or systematic reviews.
The results yielded 15 studies involving 3,888 patients. HFNC was considered successful if it was discontinued without mechanical ventilation or death. The researchers found considerably different sensitivity and specificity among the included studies, unless the tool was used within the first 12 hours after HFNC initiation. In addition, the researchers concluded that the ROX index was equally effective in predicting HFNC outcomes in patients with AHRF due to COVID-19 and those with AHRF from other causes.
“The ROX index can be a useful screening tool to identify patients likely to benefit from continued HFNC therapy or requiring alternative interventions. While the ROX index offers a simple and rapid assessment tool, clinicians should exercise caution in relying solely on a single cut-off value,” the authors concluded. As studies show varying accuracy and cut-off values of the ROX index, they called for additional research to assess the tool’s utility in various settings, such as intensive care units.
Reference
Pugazhendi I, Vaz C, Guragain A,et al. Can the ROX index accurately predict outcomes of HFNC therapy in patients with acute hypoxemic respiratory failure? A systematic review with meta-analysis. Abstract #A2781-A2782. Presented at the CHEST Annual Meeting; October 6-9, 2024; Boston, Massachusetts.
