Rox Index Dynamics According to High Flow Nasal Cannula Success in Intensive Care Unit Patients with COVID-19-Related Acute Respiratory Failure

This is the authors' abstract. We don't add key points for this paper.

Background: High-flow nasal cannula therapy has been shown to be useful in the treatment of patients with acute respiratory failure caused by severe acute respiratory syndrome-coronavirus disease-2.The ROX index can help predict the success of high-flow nasal cannula in coronavirus disease-19-related acute respiratory failure.However, the timing of ROX-index assessment is still unclear to protect the patients from complications due to early or delayed intubation.Aims: To evaluate the relation between ROX index patterns within the first 48 hours of the therapy and high-flow nasal cannula success rates.The secondary aim was to determine other possible predictors of highflow nasal cannula failure. Study design: A cross-sectional study.Methods: Patients admitted to the intensive care unit between April 2020 and January 2022 with coronavirus disease-19-related acute respiratory failure and treated with high-flow nasal cannula were included in the study.Patients' demographics, clinical characteristics and laboratory findings at intensive care unit admission; ROX indices at initiation, 2 nd , 8 th , 12 th , 24 th and 48 th hours of high-flow nasal cannula; and outcomes were recorded.Results: In the study period, 69 th patients were managed with highflow nasal cannula for at least 2 hours.While 24 patients (34.7%) were successfully weaned from high-flow nasal cannula, 45 (65.3%) patients failed.Overall mortality at day 28 was 44.9%.ROX indices were lower in the high-flow nasal cannula failure group through the 12 th , 24 th , and 48 th hours of the therapy, no significant change was observed (P = 0.33).While an overall increase in ROX index patterns were detected in patients weaned from high-flow nasal cannula (P = 0.002).Pairwise analyses revealed that ROX indexes remain stable during the first 8 th hours in both groups, then improved to 12 th hours of the therapy in successfully high-flow nasal cannula-weaned patients.Conclusion: Dynamic assessments of the ROX indexes could be more suggestive rather than a point assessment to identify patients who would benefit from the high-flow nasal cannula or deteriorate in coronavirus disease-19 related acute respiratory failure.