Liu Xiaoyi, Liu Hui, Chen Lijuan, Zheng Xiangde, Ran Hui, Chen Lili, Zhou Rui, Wang Yufeng
Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, Sichuan, China.
Ophthalmology, Dazhou Central Hospital, Dazhou, Sichuan, China.
Clin Respir J. 2025 Jul;19(7):e70098. doi: 10.1111/crj.70098.
Volume OXygenation (VOX) index has good efficacy in predicting the failure of high-flow nasal cannula therapy. However, its predictive value for treatment failure in patients receiving noninvasive ventilation (NIV) remains uncertain.
Patients who underwent early NIV treatment were grouped based on their 2-h NIV VOX Youden index. The low-risk group consisted of patients with a VOX value > 20.45 (n = 188), while the high-risk group included those with a VOX value ≤ 20.45 (n = 200). Baseline data and arterial blood gas values were collected at 2, 12, and 24 h after NIV initiation.
Compared to the low-risk group, the high-risk group exhibited higher SOFA scores, respiratory rates, and heart rates, along with a lower oxygenation index (P/F) (all p < 0.05). Following NIV treatment, the low-risk group showed a more significant increase in P/F values at 2 h, 12 h, and 24 h after NIV initiation. The low-risk group showed a lower VT and MV (minute ventilation volume) at 2 h, 12 h, and 24 h of NIV (p < 0.05). Moreover, the low-risk group had a lower intubation rate (7.98% vs. 77%, p < 0.05) and mortality rate (4.79% vs. 17.5%, p < 0.05). At 2 h of NIV, the area under the receiver operating characteristic curve for predicting NIV failure using the VOX index was 0.843 (95% CI 0.805-0.882). Using a VOX value threshold of 20.45 to predict NIV failure, the sensitivity was 69.1%, and the specificity was 94.4%. Furthermore, a VOX value ≤ 20.45 was identified as an independent risk factor for tracheal intubation and death.
VOX index shows promise to serve as an effective evaluation index to predict early NIV efficacy in patients with AHRF; a VOX value > 20.45 after 2 h of NIV treatment can better predict improvements in hypoxia, respiratory drive, and NIV outcomes, guide early tracheal intubation in cases of NIV failure, and have a certain predictive effect on patient outcomes.
容积氧合（VOX）指数在预测高流量鼻导管治疗失败方面具有良好疗效。然而，其对接受无创通气（NIV）患者治疗失败的预测价值仍不确定。
对接受早期NIV治疗的患者，根据其2小时NIV的VOX约登指数进行分组。低风险组为VOX值>20.45的患者（n = 188），高风险组为VOX值≤20.45的患者（n = 200）。在NIV开始后2、12和24小时收集基线数据和动脉血气值。
与低风险组相比，高风险组的序贯器官衰竭评估（SOFA）评分、呼吸频率和心率更高，氧合指数（P/F）更低（均p<0.05）。NIV治疗后，低风险组在NIV开始后2小时、12小时和24小时的P/F值升高更为显著。低风险组在NIV治疗2小时、12小时和24小时时的潮气量（VT）和分钟通气量（MV）更低（p<0.05）。此外，低风险组的插管率（7.98%对77%，p<0.05）和死亡率（4.79%对17.5%，p<0.05）更低。在NIV治疗2小时时，使用VOX指数预测NIV失败的受试者工作特征曲线下面积为0.843（95%可信区间0.805 - 0.882）。使用VOX值阈值20.45预测NIV失败，敏感性为69.1%，特异性为94.4%。此外，VOX值≤20.45被确定为气管插管和死亡的独立危险因素。
VOX指数有望作为预测急性低氧性呼吸衰竭（AHRF）患者早期NIV疗效的有效评估指标；NIV治疗2小时后VOX值>20.45能更好地预测缺氧、呼吸驱动和NIV结局的改善，指导NIV失败时的早期气管插管，并对患者结局有一定的预测作用。
