Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure
Abstract Background Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary anal...
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SpringerOpen
2021-01-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-021-00801-z |
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| author | Virginie Lemiale Guillaume Dumas Alexandre Demoule Frederic Pène Achille Kouatchet Magali Bisbal Saad Nseir Laurent Argaud Loay Kontar Kada Klouche Francois Barbier Amelie Seguin Guillaume Louis Jean-Michel Constantin Julien Mayaux Florent Wallet Vincent Peigne Christophe Girault Johanna Oziel Martine Nyunga Nicolas Terzi Lila Bouadma Alexandre Lautrette Naike Bige Jean-Herle Raphalen Laurent Papazian Fabrice Bruneel Christine Lebert Dominique Benoit Anne-Pascale Meert Samir Jaber Djamel Mokart Michael Darmon Elie Azoulay The Groupe de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH) |
| author_facet | Virginie Lemiale Guillaume Dumas Alexandre Demoule Frederic Pène Achille Kouatchet Magali Bisbal Saad Nseir Laurent Argaud Loay Kontar Kada Klouche Francois Barbier Amelie Seguin Guillaume Louis Jean-Michel Constantin Julien Mayaux Florent Wallet Vincent Peigne Christophe Girault Johanna Oziel Martine Nyunga Nicolas Terzi Lila Bouadma Alexandre Lautrette Naike Bige Jean-Herle Raphalen Laurent Papazian Fabrice Bruneel Christine Lebert Dominique Benoit Anne-Pascale Meert Samir Jaber Djamel Mokart Michael Darmon Elie Azoulay The Groupe de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH) |
| author_sort | Virginie Lemiale |
| collection | DOAJ |
| description | Abstract Background Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary analysis of randomized trials in immunocompromised patients, including all patients who received high-flow nasal cannula (HFNC). The first objective was to evaluate the accuracy of the ROX index to predict intubation for patients with acute respiratory failure. Results In the study, 302 patients received HFNC. Acute respiratory failure was mostly related to pneumonia (n = 150, 49.7%). Within 2 (1–3) days, 115 (38.1%) patients were intubated. The ICU mortality rate was 27.4% (n = 83). At 6 h, the ROX index was lower for patients who needed intubation compared with those who did not [4.79 (3.69–7.01) vs. 6.10 (4.48–8.68), p < 0.001]. The accuracy of the ROX index to predict intubation was poor [AUC = 0.623 (0.557–0.689)], with low performance using the threshold previously found (4.88). In multivariate analysis, a higher ROX index was still independently associated with a lower intubation rate (OR = 0.89 [0.82–0.96], p = 0.04). Conclusion A ROX index greater than 4.88 appears to have a poor ability to predict intubation in immunocompromised patients with acute respiratory failure, although it remains highly associated with the risk of intubation and may be useful to stratify such risk in future studies. |
| first_indexed | 2024-12-19T23:41:19Z |
| format | Article |
| id | doaj.art-87ffef75d4f94a30841cdf65165eb2ef |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-19T23:41:19Z |
| publishDate | 2021-01-01 |
| publisher | SpringerOpen |
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| series | Annals of Intensive Care |
| spelling | doaj.art-87ffef75d4f94a30841cdf65165eb2ef2022-12-21T20:01:25ZengSpringerOpenAnnals of Intensive Care2110-58202021-01-011111910.1186/s13613-021-00801-zPerformance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failureVirginie Lemiale0Guillaume Dumas1Alexandre Demoule2Frederic Pène3Achille Kouatchet4Magali Bisbal5Saad Nseir6Laurent Argaud7Loay Kontar8Kada Klouche9Francois Barbier10Amelie Seguin11Guillaume Louis12Jean-Michel Constantin13Julien Mayaux14Florent Wallet15Vincent Peigne16Christophe Girault17Johanna Oziel18Martine Nyunga19Nicolas Terzi20Lila Bouadma21Alexandre Lautrette22Naike Bige23Jean-Herle Raphalen24Laurent Papazian25Fabrice Bruneel26Christine Lebert27Dominique Benoit28Anne-Pascale Meert29Samir Jaber30Djamel Mokart31Michael Darmon32Elie Azoulay33The Groupe de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH)AP-HP, Hôpital Saint-Louis, Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-LouisAP-HP, Hôpital Saint-Louis, Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-LouisMedical Intensive Care Unit and Respiratory Division, APHP, Hopital Pitie-Salpetriere, Sorbonne UniversityMedical Intensive Care Unit, Hospital Cochin, APHP, Universite Paris DescartesMedical Intensive Care Unit, CHRUIntensive Care Unit, Paoli Calmettes InstituteCritical Care Center, CHU de LilleMedical Intensive Care Unit, Hospices Civils de Lyon, Hopital Edouard HerriotMedical Intensive Care Unit, INSERM U1088, Amiens University HospitalMedical Intensive Care Unit, CHU de MontpellierMedical Intensive Care Unit, La Source Hospital, CHR OrleansMedical Intensive Care Unit, Hotel Dieu, CHU de NantesIntensive Care Unit, CHR de Metz-ThionvilleDepartment of Perioperative Medicine, CHU Clermont-FerrandMedical Intensive Care Unit and Respiratory Division, APHP, Hopital Pitie-Salpetriere, Sorbonne UniversityIntensive Care Unit, Lyon Sud Medical CenterIntensive Care Unit, Centre Hospitalier Metropole-SavoieMedical Intensive Care Unit, Hospital Charles NicolleMedical Intensive Care Unit, Avicenne University HospitalIntensive Care Unit, Roubaix HospitalMedical Intensive Care Unit, CHU de Grenoble AlpesMedical Intensive Care Unit, CHU BichatMedical Intensive Care Unit, Gabriel-Montpied University HospitalMedical Intensive Care Unit, CHU St-AntoineDepartment of Anesthesia and Critical Care, Necker HospitalReanimation Des Detresses Respiratoires Et Infections Severes, Assistance Publique—Hopitaux de Marseille, Hopital Nord, Faculte de Medecine, Aix-Marseille UniversiteMedical Intensive Care Unit, Andre Mignot HospitalIntensive Care Unit, Centre Hospitalier Departemental Les OudairiesDepartment of Intensive Care, Ghent University HospitalService de Médecine Interne, Soins Intensifs & Urgences Oncologiques, Institut Jules Bordet, Bruxelles, Université Libre de Bruxelles (ULB)Montpellier University Hospital, PhyMedExp, INSERM U-1046, CNRSIntensive Care Unit, Paoli Calmettes InstituteAP-HP, Hôpital Saint-Louis, Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-LouisAP-HP, Hôpital Saint-Louis, Medical Intensive Care Unit and Department of Biostatistics, APHP, Hopital St-LouisAbstract Background Delayed intubation is associated with high mortality. There is a lack of objective criteria to decide the time of intubation. We assessed a recently described combined oxygenation index (ROX index) to predict intubation in immunocompromised patients. The study is a secondary analysis of randomized trials in immunocompromised patients, including all patients who received high-flow nasal cannula (HFNC). The first objective was to evaluate the accuracy of the ROX index to predict intubation for patients with acute respiratory failure. Results In the study, 302 patients received HFNC. Acute respiratory failure was mostly related to pneumonia (n = 150, 49.7%). Within 2 (1–3) days, 115 (38.1%) patients were intubated. The ICU mortality rate was 27.4% (n = 83). At 6 h, the ROX index was lower for patients who needed intubation compared with those who did not [4.79 (3.69–7.01) vs. 6.10 (4.48–8.68), p < 0.001]. The accuracy of the ROX index to predict intubation was poor [AUC = 0.623 (0.557–0.689)], with low performance using the threshold previously found (4.88). In multivariate analysis, a higher ROX index was still independently associated with a lower intubation rate (OR = 0.89 [0.82–0.96], p = 0.04). Conclusion A ROX index greater than 4.88 appears to have a poor ability to predict intubation in immunocompromised patients with acute respiratory failure, although it remains highly associated with the risk of intubation and may be useful to stratify such risk in future studies.https://doi.org/10.1186/s13613-021-00801-zHigh-flow nasal oxygenImmunocompromisedAcute respiratory failure |
| spellingShingle | Virginie Lemiale Guillaume Dumas Alexandre Demoule Frederic Pène Achille Kouatchet Magali Bisbal Saad Nseir Laurent Argaud Loay Kontar Kada Klouche Francois Barbier Amelie Seguin Guillaume Louis Jean-Michel Constantin Julien Mayaux Florent Wallet Vincent Peigne Christophe Girault Johanna Oziel Martine Nyunga Nicolas Terzi Lila Bouadma Alexandre Lautrette Naike Bige Jean-Herle Raphalen Laurent Papazian Fabrice Bruneel Christine Lebert Dominique Benoit Anne-Pascale Meert Samir Jaber Djamel Mokart Michael Darmon Elie Azoulay The Groupe de Recherche en Reanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH) Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure Annals of Intensive Care High-flow nasal oxygen Immunocompromised Acute respiratory failure |
| title | Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure |
| title_full | Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure |
| title_fullStr | Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure |
| title_full_unstemmed | Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure |
| title_short | Performance of the ROX index to predict intubation in immunocompromised patients receiving high-flow nasal cannula for acute respiratory failure |
| title_sort | performance of the rox index to predict intubation in immunocompromised patients receiving high flow nasal cannula for acute respiratory failure |
| topic | High-flow nasal oxygen Immunocompromised Acute respiratory failure |
| url | https://doi.org/10.1186/s13613-021-00801-z |
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