de Carvalho Victor Côrtes Pourchet, da Silva Guimarães Bruno Leonardo, Fujihara Mellina Tamy Fagundes, Ceotto Victor Fraga, Turon Ricardo, Lugon Jocemir Ronaldo, Gismondi Ronaldo Altenburg Odebrecht Curi
Department of Medicine, Medical School, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil.
Intensive Care Unit, Hospital Niteroi D'Or, Niteroi, Rio de Janeiro, Brazil.
Am J Emerg Med. 2023 Nov;73:160-165. doi: 10.1016/j.ajem.2023.08.045. Epub 2023 Sep 1.
High flow nasal cannula (HFNC) is used to prevent invasive ventilation in COVID-19-associated hypoxemia. The respiratory rate‑oxygenation (ROX) index has been reported to predict failure of HFNC in patients with COVID-19 pneumonia during the intensive care unit stay when measured in first hours of therapy. However, the clinical course of ICU patients may change substantially in the first days of admission. The objective of this study was to investigate whether ROX index obtained in the first four days of ICU admission could predict the need for invasive respiratory support within the next 24 h of measurements.
A retrospective cross-sectional study was performed using a database that included adult patients with COVID-19 pneumonia treated in the ICU. Patients were followed from ICU admission and ROX index was calculated daily on HFNC. Receiver operating characteristics curves (ROCs) were performed.
Two hundred forty-nine patients were enrolled, 48% of whom require mechanical ventilation (MV). The area under the ROC of the pooled 4-day values of the ROX index as a predictor of transition from HFNC to MV within 24 h of measurements was 0.86 (95%CI 0.83 to 0.88, P < 0.001) with a cutoff point of 4.06.
In COVID-19 patients in high flow nasal cannula, daily ROX index measurements successfully predicted transition to mechanical ventilation within the next 24 h.
高流量鼻导管（HFNC）用于预防新型冠状病毒肺炎相关低氧血症患者进行有创通气。据报道，在重症监护病房（ICU）治疗的最初数小时内测量呼吸频率-氧合（ROX）指数，可预测新型冠状病毒肺炎患者使用HFNC失败的情况。然而，ICU患者的临床病程在入院后的头几天可能会发生显著变化。本研究的目的是调查在ICU入院的前四天获得的ROX指数是否能预测在接下来测量的24小时内是否需要有创呼吸支持。
采用回顾性横断面研究，使用一个包含在ICU接受治疗的成年新型冠状病毒肺炎患者的数据库。从患者入住ICU开始进行随访，并每天计算其使用HFNC时的ROX指数。绘制受试者工作特征曲线（ROC）。
共纳入249例患者，其中48%需要机械通气（MV）。作为测量后24小时内从HFNC过渡到MV的预测指标，ROX指数合并4天值的ROC曲线下面积为0.86（95%可信区间0.83至0.88，P<0.001），截断点为4.06。
对于使用高流量鼻导管的新型冠状病毒肺炎患者，每日测量ROX指数可成功预测在接下来的24小时内是否会过渡到机械通气。
