• Ryan Brewster, Sitarah Mathias, Suraj Sarvode, Dileep Unnikrishnan, Dileep Raman, Brody Foy, Carl Britto, and Cloudphysician tele-ICU consortium.
• Department of Pediatrics, Boston Children's Hospital, Boston, USA.
• J Crit Care. 2024 Aug 1; 82: 154812154812.

PurposeIdentifying thresholds at which the ROX index would satisfactorily predict HFNC failure across heterogenous resourced contexts is necessary for clinical use.MethodsPatients ≥18 years admitted to 30 diverse ICUs across 10 states in India who required HFNC for respiratory support were retrospectively included in this study. Patient data and hourly ROX indices were then analyzed and contextualized to clinical outcomes as well as with ROX index thresholds in other regions of the world.Measurements And Main ResultsAmong the 614 patients included, 276 (44.9%) required respiratory escalation. Pneumonia was the most common diagnosis on admission. Receiver operating characteristic curve analysis revealed that a baseline ROX score of 7.86 was similar to 4.88 in other populations which was confirmed by Kaplan-Mier curves (hazard ratio,3.58 (2.72-4.69, p < 0.001)). ROX scores at 11.84 or 5.89 had roles in screening and confirming HFNC failure. The index performed poorly in a subset of patients who died without respiratory escalation. The ROX index was most predictive in the initial hours of ICU admission and a longer duration of HFNC was associated with more severe outcomes.ConclusionsWhen optimally calibrated this index can using a method that can reliably predict the risk of HFNC failure among ICU patients from diverse settings.Copyright © 2024 Elsevier Inc. All rights reserved.

19 keywords...

hide…