Consecutive hospitalized patients diagnosed with SARS-CoV-2 infection between February 10, 2020, and February 28, 2021, were retrospectively reviewed. Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were classified based on severity, and patients with moderate to severe infections were admitted to nationally designated treatment facilities. This multicenter study was conducted at seven university-affiliated hospitals in Korea with nationally designated isolation units. Furthermore, we evaluated the factors affecting mortality in these patients. We aimed to determine the predictive function of the ROX index and the SF ratio in COVID-19 patients after HFNC initiation. Hence, we hypothesized that the SF ratio had a comparable prediction ability with the ROX index in patients with severe COVID-19. Moreover, unlike traditional respiratory failure, COVID-19 often presents with silent hypoxia, a condition where the patient has no abnormal respiratory pattern despite severe hypoxia therefore, respiratory rate may not be crucial in predicting HFNC failure in COVID-19. Notably, the SF ratio has been reported as a reliable factor for predicting failure of HFNC or non-invasive ventilation in clinical practice when arterial blood gas sampling is not readily available. The SpO 2/FiO 2 (SF) ratio, which correlates with the partial pressure of oxygen PaO 2/FiO 2 (PF) ratio, can also be utilized as a prognostic marker for acute hypoxemic respiratory failure. However, whether the ROX index is effective for predicting intubation and whether the cut-off of the ROX index is appropriate in patients with COVID-19 remain unknown. reported that an ROX index cut-off of 4.88 measured 12 h after HFNC initiation was associated with a lower risk of need for intubation, suggesting that the ROX index can help identify patients at high risk for intubation. The ratio of oxygen saturation (ROX) index, defined as the ratio of oxygen saturation (SpO 2)/fraction of inspired oxygen (FiO 2) to respiratory rate, has been proposed to detect HFNC failure. Therefore, predicting HFNC failure and determining the appropriate timing of endotracheal intubation are important strategies for HFNC treatment. However, failure of HFNC may cause delayed intubation and increased mortality. HFNC could reduce the rate of endotracheal intubation in patients with acute respiratory failure compared with conventional oxygen therapy. High-flow nasal cannula (HFNC) has been widely used in patients with hypoxemic respiratory failure. Sequential organ failure assessment APACHE II,Īcute physiology and chronic health evaluation II Severe acute respiratory syndrome coronavirus 2 ROC, This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: The author(s) received no specific funding for this work.Ĭompeting interests: The authors have declared that no competing interests exist.
Received: NovemAccepted: ApPublished: May 12, 2022Ĭopyright: © 2022 Kim et al. PLoS ONE 17(5):Įditor: Vijay Hadda, AIIMS: All India Institute of Medical Sciences, INDIA (2022) ROX index and SpO 2/FiO 2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study. So, HFNC treatment should be carried out in a negative pressure room when it is not possible, devices should be undertaken in a single room.Citation: Kim JH, Baek A-R, Lee S-I, Kim W-Y, Na YS, Lee BY, et al. Besides that, the use of high-flow oxygen cannulas can produce aerosols. Also HFNC can in achieving apneic oxygenation in patients during airway management. HFNC can reduce the requiring of intubation in patients with COVID-19, and it can decrease the length of intensive care unit stay, and complications related to mechanical ventilation. The available reports suggest that HFNC provides high concentrations of oxygen to the patients, who can not reach with conventional devices. Considering the debates about the use of HFNC, we reviewed the literature related to the usage of HFNC in COVID-19. However, in COVID-19, the usage of HFNC is much controversial due to concerns about the benefits and risk of aerosol-dispersion.
HFNC provides higher concentration and flow of oxygen, resulting in decreasing anatomic dead space by preventing rebreathing and ensure positive end-expiratory. In recent years, high flow nasal cannula (HFNC) is a respiratory support system that has become prominent in the treatment of respiratory failure.
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