Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia.
<h4>Background</h4>High-flow nasal cannula (HFNC) therapy is commonly used to treat acute respiratory failure in patients with COVID-19 pneumonia. However, predictors of successful weaning from HFNC in these patients has not been investigated.<h4>Objective</h4>To assess predi...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0297624&type=printable |
| _version_ | 1797301424148709376 |
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| author | Pitchayapa Ruchiwit Jaturong Madua Narongkorn Saiphoklang |
| author_facet | Pitchayapa Ruchiwit Jaturong Madua Narongkorn Saiphoklang |
| author_sort | Pitchayapa Ruchiwit |
| collection | DOAJ |
| description | <h4>Background</h4>High-flow nasal cannula (HFNC) therapy is commonly used to treat acute respiratory failure in patients with COVID-19 pneumonia. However, predictors of successful weaning from HFNC in these patients has not been investigated.<h4>Objective</h4>To assess predictors of successful separation from HFNC in patients with COVID-19 pneumonia.<h4>Methods</h4>We conducted a retrospective cohort study at a university hospital in Thailand. Patients with COVID-19 pneumonia requiring HFNC therapy between April 2020 and June 2022 were included. ROX index was defined as the ratio of oxygen saturation (SpO2) / fraction of inspired oxygen (FiO2) to respiratory rate. Heart-ROX (HROX) index was defined as ROX multiplied by heart rate (HR) improvement. HR improvement (delta-HR) was defined as a percentage of the difference between the baseline HR and the morning HR at HFNC weaning day 1 divided by the baseline HR. Weaning success was defined as ability to sustain spontaneous breathing after separation from HFNC without any invasive or non-invasive ventilatory support for ≥48 hours or death.<h4>Results</h4>A total of 164 patients (54% male) were included. Mean age was 61.1±16.1 years. Baseline SpO2/FiO2 was 265.3±110.8. HFNC weaning success was 77.4%. The best cut-off value of ROX index to predict HFNC weaning success was 7.88 with 100% sensitivity, 97.3% specificity, and area under the ROC curve (AUC) of 0.98 (95% CI: 0.937-1.000, p<0.001). The best cut-off value of delta-HR 3.7 with 88.2% sensitivity, 75.7% specificity, and AUC of 0.83 (95% CI: 0.748-0.919, p<0.001). The best cut-off value of HROX index was 59.2 with 88.2% sensitivity, 81.1% specificity, and AUC of 0.89, (95% CI: 0.835-0.953, p<0.001).<h4>Conclusions</h4>The ROX index has the highest accuracy for predicting successful weaning off HFNC treatment in patients with COVID-19 pneumonia. While HROX and delta-HR indices can serve as alternative tools, it is recommended to verify these indices and determine the optimal cut-off value for determining separation from HFNC therapy through a large prospective cohort study.<h4>Trial registration</h4>Clinicaltrials.in.th number: TCTR20221108004. |
| first_indexed | 2024-03-07T23:21:24Z |
| format | Article |
| id | doaj.art-ece8473551024d288db79ced4858a6e9 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-07T23:21:24Z |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-ece8473551024d288db79ced4858a6e92024-02-21T05:31:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032024-01-01192e029762410.1371/journal.pone.0297624Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia.Pitchayapa RuchiwitJaturong MaduaNarongkorn Saiphoklang<h4>Background</h4>High-flow nasal cannula (HFNC) therapy is commonly used to treat acute respiratory failure in patients with COVID-19 pneumonia. However, predictors of successful weaning from HFNC in these patients has not been investigated.<h4>Objective</h4>To assess predictors of successful separation from HFNC in patients with COVID-19 pneumonia.<h4>Methods</h4>We conducted a retrospective cohort study at a university hospital in Thailand. Patients with COVID-19 pneumonia requiring HFNC therapy between April 2020 and June 2022 were included. ROX index was defined as the ratio of oxygen saturation (SpO2) / fraction of inspired oxygen (FiO2) to respiratory rate. Heart-ROX (HROX) index was defined as ROX multiplied by heart rate (HR) improvement. HR improvement (delta-HR) was defined as a percentage of the difference between the baseline HR and the morning HR at HFNC weaning day 1 divided by the baseline HR. Weaning success was defined as ability to sustain spontaneous breathing after separation from HFNC without any invasive or non-invasive ventilatory support for ≥48 hours or death.<h4>Results</h4>A total of 164 patients (54% male) were included. Mean age was 61.1±16.1 years. Baseline SpO2/FiO2 was 265.3±110.8. HFNC weaning success was 77.4%. The best cut-off value of ROX index to predict HFNC weaning success was 7.88 with 100% sensitivity, 97.3% specificity, and area under the ROC curve (AUC) of 0.98 (95% CI: 0.937-1.000, p<0.001). The best cut-off value of delta-HR 3.7 with 88.2% sensitivity, 75.7% specificity, and AUC of 0.83 (95% CI: 0.748-0.919, p<0.001). The best cut-off value of HROX index was 59.2 with 88.2% sensitivity, 81.1% specificity, and AUC of 0.89, (95% CI: 0.835-0.953, p<0.001).<h4>Conclusions</h4>The ROX index has the highest accuracy for predicting successful weaning off HFNC treatment in patients with COVID-19 pneumonia. While HROX and delta-HR indices can serve as alternative tools, it is recommended to verify these indices and determine the optimal cut-off value for determining separation from HFNC therapy through a large prospective cohort study.<h4>Trial registration</h4>Clinicaltrials.in.th number: TCTR20221108004.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0297624&type=printable |
| spellingShingle | Pitchayapa Ruchiwit Jaturong Madua Narongkorn Saiphoklang Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia. PLoS ONE |
| title | Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia. |
| title_full | Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia. |
| title_fullStr | Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia. |
| title_full_unstemmed | Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia. |
| title_short | Comparison of ROX, HROX, and delta-HR indices to predict successful weaning from high-flow oxygen therapy in hospitalized patients with COVID-19 pneumonia. |
| title_sort | comparison of rox hrox and delta hr indices to predict successful weaning from high flow oxygen therapy in hospitalized patients with covid 19 pneumonia |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0297624&type=printable |
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