• Victor Côrtes Pourchet de Carvalho, Bruno Leonardo da Silva Guimarães, Mellina Tamy Fagundes Fujihara, Victor Fraga Ceotto, Ricardo Turon, Jocemir Ronaldo Lugon, and GismondiRonaldo Altenburg Odebrecht CuriRAOCDepartment of Medicine, Medical School, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil..
• Department of Medicine, Medical School, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil. Electronic address: torcortes@yahoo.com.br.
• Am J Emerg Med. 2023 Nov 1; 73: 160165160-165.

IntroductionHigh 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.MethodsA 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.ResultsTwo 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.ConclusionIn COVID-19 patients in high flow nasal cannula, daily ROX index measurements successfully predicted transition to mechanical ventilation within the next 24 h.Copyright © 2023 Elsevier Inc. All rights reserved.

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