Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
Green Templeton College, University of Oxford, Oxford, OX26HG, UK.
Eur J Pediatr. 2022 Nov;181(11):3977-3983. doi: 10.1007/s00431-022-04607-4. Epub 2022 Sep 14.
Our objective was to evaluate the association of respiratory rate oxygenation index (ROX) with the need for positive pressure ventilation in children < 2 years of age with bronchiolitis on high flow nasal cannula (HFNC) therapy. We performed a single-center prospective observational study of a convenience sample of children < 2 years of age with bronchiolitis who had HFNC initiated in the pediatric emergency department between November and March, 2018-2020. ROX was calculated as pulse oximetry/FiO/respiratory rate at HFNC initiation. Demographics, need for positive pressure ventilation (PPV), disposition, and hospital length of stay were collected. Logistic regression model was used to determine the odds ratio for PPV need relative to the highest ROX quartile. Of the 373 patients included, 49 (13.1%) required PPV. ROX was lower in patients who required PPV compared with those who did not (5.86 [4.71-7.42] vs. 6.74 [5.46-8.25]; p = 0.01). Logistic regression revealed that those patients whose ROX was in the lowest quartile (< 5.39) were three times more likely to require PPV compared to those in the highest quartile (> 8.21). These results held true after adjusting for confounders (odds ratio 3.1; 95% CI [1.3 to 7.5]; p = 0.02). The model's AUROC (0.701) indicated acceptable discrimination between cases and controls.
Low ROX index was associated with the need for PPV in children with bronchiolitis on HFNC. The risk stratification provided and ROX threshold for risk stratification require confirmation in other populations with a larger sample size.
• Demographic and clinical factors associated with high flow nasal cannula (HFNC) therapy in children with bronchiolitis has been studied.
• This is the first study to report the utility of association of Respiratory Rate Oxygenation (ROX) index for need for positive pressure ventilation (PPV) in children < 2 years of age with bronchiolitis on HFNC therapy. • ROX was lower in children who required PPV and children whose ROX was in the lowest quartile (< 5.39) were three times more likely to require PPV compared to those in the highest quartile (> 8.21).
评估呼吸频率氧合指数（ROX）与接受高流量鼻导管（HFNC）治疗的 2 岁以下毛细支气管炎患儿需要正压通气的相关性。我们对 2018 年 11 月至 2020 年 3 月期间在儿科急诊科接受 HFNC 治疗的毛细支气管炎患儿进行了一项单中心前瞻性观察性研究。ROX 是在开始 HFNC 时通过脉搏血氧仪/FiO2/呼吸频率计算得出的。收集了人口统计学数据、需要正压通气（PPV）、处置情况和住院时间。使用逻辑回归模型确定与最高 ROX 四分位值相关的 PPV 需求的比值比。在纳入的 373 例患者中，49 例（13.1%）需要 PPV。与不需要 PPV 的患者相比，需要 PPV 的患者的 ROX 更低（5.86 [4.71-7.42] 比 6.74 [5.46-8.25]；p=0.01）。逻辑回归显示，ROX 最低四分位（<5.39）的患者与最高四分位（>8.21）的患者相比，需要 PPV 的可能性高 3 倍。在调整混杂因素后（比值比 3.1；95%CI [1.3 至 7.5]；p=0.02），这些结果仍然成立。该模型的 AUROC（0.701）表明病例与对照组之间具有可接受的区分度。
低 ROX 指数与接受 HFNC 治疗的毛细支气管炎患儿需要 PPV 相关。需要在其他人群中使用更大的样本量进一步验证风险分层提供的和用于风险分层的 ROX 阈值。
• 已经研究了与接受高流量鼻导管（HFNC）治疗的毛细支气管炎患儿相关的人口统计学和临床因素。
• 这是第一项报告呼吸频率氧合（ROX）指数与接受 HFNC 治疗的 2 岁以下毛细支气管炎患儿需要正压通气（PPV）之间相关性的研究。• 需要 PPV 的患儿的 ROX 较低，而 ROX 最低四分位（<5.39）的患儿需要 PPV 的可能性是 ROX 最高四分位（>8.21）患儿的 3 倍。
