ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study
Abstract Background High-flow nasal cannula has been a promising initial respiratory support measure for patients with acute hypoxemic respiratory failure (AHRF) in the emergency department (ED). However, delayed detection of HFNC failure is associated with increased mortality. The ROX index is a to...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-023-00477-1 |
| _version_ | 1828063880089174016 |
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| author | Nattakarn Praphruetkit Natyada Boonchana Apichaya Monsomboon Onlak Ruangsomboon |
| author_facet | Nattakarn Praphruetkit Natyada Boonchana Apichaya Monsomboon Onlak Ruangsomboon |
| author_sort | Nattakarn Praphruetkit |
| collection | DOAJ |
| description | Abstract Background High-flow nasal cannula has been a promising initial respiratory support measure for patients with acute hypoxemic respiratory failure (AHRF) in the emergency department (ED). However, delayed detection of HFNC failure is associated with increased mortality. The ROX index is a tool that can help predict HFNC success. Nonetheless, its utility in ED patients is limited, and no studies have compared it with the HACOR scale, another tool that may be as accurate in predicting HFNC failure. Therefore, we aimed to compare the prognostic utility of the ROX index and the HACOR scale in emergency AHRF patients. Methods This prospective observational study was conducted at the ED of Siriraj Hospital, Thailand, between August 2018 and February 2020. Adult patients with AHRF requiring HFNC in the ED were included. The ROX index and the HACOR scale were measured at 1, 2, and 6 h after HFNC initiation. The primary outcome was HFNC success, defined as no intolerance or escalation towards mechanical ventilation or non-invasive ventilation within 48 h. Results A total of 75 patients were enrolled; 52 (69.3%) had a successful treatment. The ROX index was higher in the success group, while the HACOR scale was lower at all timepoints. The ROX index yielded generally higher discrimination capacity based on the area under the receiver operating characteristic curve (AUROC) than the HACOR scale [AUROC at 1, 2, and 6 h = 0.815, 0.784, 0.853 for ROX in predicting HFNC success and 0.733, 0.690, and 0.764 for HACOR in predicting HFNC failure]. The ROX index measured at 6 h at the cut-point of 4.88 had 92.98% sensitivity, 61.11% specificity, 88.33% positive predictive value, and 73.33% negative predictive value with a diagnostic accuracy of 85.33%. Conclusion The ROX index had superior prognostic utility in predicting HFNC outcome (success/failure) compared to the HACOR scale in patients with AHRF in the ED setting. Moreover, it is less complex and more efficient to be employed at bedside. Therefore, the ROX index is a more appropriate tool to guide further management and potential escalation therapy for AHRF patients with HFNC therapy initiated in the ED. |
| first_indexed | 2024-04-10T22:50:01Z |
| format | Article |
| id | doaj.art-05742af38242404aa9c7e58579f61783 |
| institution | Directory Open Access Journal |
| issn | 1865-1380 |
| language | English |
| last_indexed | 2024-04-10T22:50:01Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-05742af38242404aa9c7e58579f617832023-01-15T12:03:40ZengBMCInternational Journal of Emergency Medicine1865-13802023-01-0116111110.1186/s12245-023-00477-1ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational studyNattakarn Praphruetkit0Natyada Boonchana1Apichaya Monsomboon2Onlak Ruangsomboon3Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDepartment of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDepartment of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDepartment of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol UniversityAbstract Background High-flow nasal cannula has been a promising initial respiratory support measure for patients with acute hypoxemic respiratory failure (AHRF) in the emergency department (ED). However, delayed detection of HFNC failure is associated with increased mortality. The ROX index is a tool that can help predict HFNC success. Nonetheless, its utility in ED patients is limited, and no studies have compared it with the HACOR scale, another tool that may be as accurate in predicting HFNC failure. Therefore, we aimed to compare the prognostic utility of the ROX index and the HACOR scale in emergency AHRF patients. Methods This prospective observational study was conducted at the ED of Siriraj Hospital, Thailand, between August 2018 and February 2020. Adult patients with AHRF requiring HFNC in the ED were included. The ROX index and the HACOR scale were measured at 1, 2, and 6 h after HFNC initiation. The primary outcome was HFNC success, defined as no intolerance or escalation towards mechanical ventilation or non-invasive ventilation within 48 h. Results A total of 75 patients were enrolled; 52 (69.3%) had a successful treatment. The ROX index was higher in the success group, while the HACOR scale was lower at all timepoints. The ROX index yielded generally higher discrimination capacity based on the area under the receiver operating characteristic curve (AUROC) than the HACOR scale [AUROC at 1, 2, and 6 h = 0.815, 0.784, 0.853 for ROX in predicting HFNC success and 0.733, 0.690, and 0.764 for HACOR in predicting HFNC failure]. The ROX index measured at 6 h at the cut-point of 4.88 had 92.98% sensitivity, 61.11% specificity, 88.33% positive predictive value, and 73.33% negative predictive value with a diagnostic accuracy of 85.33%. Conclusion The ROX index had superior prognostic utility in predicting HFNC outcome (success/failure) compared to the HACOR scale in patients with AHRF in the ED setting. Moreover, it is less complex and more efficient to be employed at bedside. Therefore, the ROX index is a more appropriate tool to guide further management and potential escalation therapy for AHRF patients with HFNC therapy initiated in the ED.https://doi.org/10.1186/s12245-023-00477-1High-flow nasal cannulaNasal high flowROX indexHACOR scale |
| spellingShingle | Nattakarn Praphruetkit Natyada Boonchana Apichaya Monsomboon Onlak Ruangsomboon ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study International Journal of Emergency Medicine High-flow nasal cannula Nasal high flow ROX index HACOR scale |
| title | ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study |
| title_full | ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study |
| title_fullStr | ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study |
| title_full_unstemmed | ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study |
| title_short | ROX index versus HACOR scale in predicting success and failure of high-flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure: a prospective observational study |
| title_sort | rox index versus hacor scale in predicting success and failure of high flow nasal cannula in the emergency department for patients with acute hypoxemic respiratory failure a prospective observational study |
| topic | High-flow nasal cannula Nasal high flow ROX index HACOR scale |
| url | https://doi.org/10.1186/s12245-023-00477-1 |
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