Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
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Analysis of ROX Index, ROX-HR Index, and SpO2/FIO2 Ratio in Patients Who Received High-Flow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit

고유량 비강 캐뉼라 산소요법을 받은 소아중환자실 환아의 ROX Index와 ROX-HR Index 및 SpO2/FIO2 Ratio분석

  • Choi, Sun Hee (Hospice and Palliative Care Team, The Catholic University of Korea, Seoul St. Mary's Hospital) ;
  • Kim, Dong Yeon (Nursing Innovation Unit, The Catholic University of Korea, Seoul St. Mary's Hospital) ;
  • Song, Byung Yun (Healthcare Quality Policy Team, The Catholic Education Foundation) ;
  • Yoo, Yang Sook (Department of Clinical Nursing, College of Nursing, The Catholic University of Korea)
  • 최선희 (가톨릭대학교 서울성모병원 호스피스완화의료팀) ;
  • 김동연 (가톨릭대학교 서울성모병원 간호혁신Unit) ;
  • 송병은 (학교법인 가톨릭학원 의료질관리정책팀) ;
  • 유양숙 (가톨릭대학교 간호대학 임상간호학과)
  • Received : 2022.12.14
  • Accepted : 2023.05.17
  • Published : 2023.08.31
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Abstract

Purpose: This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. Methods: A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ2 test, Mann-Whitney U test, and area under the curve (AUC). Results: Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. Conclusion: The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

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References

  1. Suh GY. Acute respiratory failure and interpretation of chest radiograph in the intensive care unit. Journal of Neurocritical Care. 2012;5(1):17-20.
  2. Choi SJ, Yoon HS, Yoon JS. Respiratory distress in children and adolescents. Journal of the Korean Medical Association. 2014;57(8):685-692. https://doi.org/10.5124/jkma.2014.57.8.685
  3. Park S. Treatment of acute respiratory failure: High-flow nasal cannula. Journal of the Korean Medical Association. 2022;65(3):131-143. https://doi.org/10.5124/jkma.2022.65.3.131
  4. Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. The New England Journal of Medicine. 2015;372(23):2185-2196. https://doi.org/10.1056/NEJMoa1503326
  5. Krachman JA, Patricoski JA, Le CT, Park J, Zhang R, Gong KD, et al. Predicting flow rate escalation for pediatric patients on high flow nasal cannula using machine learning. Frontiers in Pediatrics. 2021;9:734753. https://doi.org/10.3389/fped.2021.734753
  6. Eun SW, Kim TK, Jeon JC, Jin SC, Choi WI. Early predictors of high-flow nasal cannula oxygen therapy failure in the emergency room. Keimyung Medical Journal. 2018;37(2):66-75. https://doi.org/10.0000/kmj.2018.37.2.66
  7. Kim JH, Baek AR, Lee SI, Kim WY, Na YS, Lee BY, et al. ROX index and SpO2/FiO2 ratio for predicting high-flow nasal cannula failure in hypoxemic COVID-19 patients: A multicenter retrospective study. PLoS One. 2022;17(5):e0268431. https://doi.org/10.1371/journal.pone.0268431
  8. Goh KJ, Chai HZ, Ong TH, Sewa DW, Phua GC, Tan QL. Early prediction of high flow nasal cannula therapy outcomes using a modified ROX index incorporating heart rate. Journal of Intensive Care. 2020;8:41. https://doi.org/10.1186/s40560-020-00458-z
  9. Lohano PD, Baloch SH, Gowa MA, Raza SJ, Soomro L, Nawaz H. Correlation between the ratio of oxygen saturation to fraction of inspired oxygen and the ratio of partial pressure of oxygen to fraction of inspired oxygen in detection and risk stratification of pediatric acute respiratory distress syndrome. Cureus. 2021;13(9):e18353. https://doi.org/10.7759/cureus.18353
  10. Fukuda Y, Tanaka A, Homma T, Kaneko K, Uno T, Fujiwara A, et al. Utility of SpO2/FiO2 ratio for acute hypoxemic respiratory failure with bilateral opacities in the ICU. PLoS One. 2021;16(1):e0245927. https://doi.org/10.1371/journal.pone.0245927
  11. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB; National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Network. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest. 2007;132(2):410-417. https://doi.org/10.1378/chest.07-0617
  12. Khemani RG, Patel NR, Bart RD 3rd, Newth CJL. Comparison of the pulse oximetric saturation/fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest. 2009;135(3):662-668. https://doi.org/10.1378/chest.08-2239
  13. Kim HJ, Lee DW, Lee JW, Moon HJ, Choi JH, Joeng DK, et al. Factors about failure after high flow oxygen through nasal cannula therapy in hypoxic respiratory failure patients at emergency department presentation. Journal of the Korean Society of Emergency Medicine. 2016;27(6):580-585. https://doi.org/10.0000/jksem.2016.27.6.580
  14. Webb LV, Chahine R, Aban I, Prabhakaran P, Loberger JM. Predicting high-flow nasal cannula therapy outcomes using the ROX-HR index in the pediatric ICU. Respiratory Care. 2022;67(11):1377-1384. https://doi.org/10.4187/respcare.09765
  15. Saelim K, Thirapaleka B, Ruangnapa K, Prasertsan P, Anuntaseree W. Predictors of high-flow nasal cannula failure in pediatric patients with acute respiratory distress. Clinical and Experimental Pediatrics. 2022;65(12):595-601. https://doi.org/10.3345/cep.2022.00241
  16. Gianstefani A, Farina G, Salvatore V, Alvau F, Artesiani ML, Bonfatti S, et al. Role of ROX index in the first assessment of COVID-19 patients in the emergency department. Internal and Emergency Medicine. 2021;16(7):1959-1965. https://doi.org/10.1007/s11739-021-02675-2
  17. Chandel A, Patolia S, Brown AW, Collins AC, Sahjwani D, Khangoora V, et al. High-flow nasal cannula therapy in COVID-19: Using the ROX Index to predict success. Respiratory Care. 2021;66(6):909-919. https://doi.org/10.4187/respcare.08631
  18. Calligaro GL, Lalla U, Audley G, Gina P, Miller MG, Mendelson M, et al. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study. EClinicalMedicine. 2020;28:100570. https://doi.org/10.1016/j.eclinm.2020.100570
  19. Yildizdas D, Yontem A, Iplik G, Horoz OO, Ekinci F. Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children. European Journal of Pediatrics. 2021;180(4):1099-1106. https://doi.org/10.1007/s00431-020-03847-6
  20. Pollack MM, Dean JM, Butler J, Holubkov R, Doctor A, Meert KL, et al. The ideal time interval for critical care severity-of-illness assessment. Pediatric Critical Care Medicine. 2013;14(5):448-453. https://doi.org/10.1097/PCC.0b013e31828a7270
  21. Roca O, Messika J, Caralt B, Garcia-de-Acilu M, Sztrymf B, Ricard JD, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. Journal of Critical Care. 2016;35:200-205. https://doi.org/10.1016/j.jcrc.2016.05.022
  22. Jang JG, Park YS, Park HY, Hwang TS. Predictors of intubation and mechanical ventilation in patients with acute respiratory failure treated with high flow nasal cannula in emergency room: The usefulness of arterial blood gas analysis. Journal of the Korean Society of Emergency Medicine. 2021;32(4):281-289.
  23. Chang CC, Lin YC, Chen TC, Lin JJ, Hsia SH, Chan OW, et al. High-flow nasal cannula therapy in children with acute respiratory distress with hypoxia in a pediatric intensive care unita single center experience. Frontiers in Pediatrics. 2021;9:664180. https://doi.org/10.3389/fped.2021.66418
  24. Vasquez-Hoyos P, Jimenez-Chaves A, Tovar-Velasquez M, Albor-Ortega R, Palencia M, Redondo-Pastrana D, et al. Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude. Medicina Intensiva (English Edition). 2021;45(4):195-204. https://doi.org/10.1016/j.medine.2021.02.002
  25. Liu J, Li D, Luo L, Liu Z, Li X, Qiao L. Analysis of risk factors for the failure of respiratory support with high-flow nasal cannula oxygen therapy in children with acute respiratory dysfunction: A case-control study. Frontiers in Pediatrics. 2022;10:979944. https://doi.org/10.3389/fped.2022.979944
  26. Satapathy AK, Das RR, Mahapatro S, Panigrahi MK, Bandopadhaya D. Effect of body mass index (BMI) on pulmonary functions in children of 6-14 years of age: A cross-sectional study. Journal of Family Medicine and Primary Care. 2022;11(6):3156-3160. https://doi.org/10.4103/jfmpc.jfmpc_2002_21
  27. Lee YS, Chang SW, Sim JK, Kim S, Kim JH. An integrated model including the ROX Index to predict the success of high-flow nasal cannula use after planned extubation: A retrospective observational cohort study. Journal of Clinical Medicine. 2021;10(16):3513. https://doi.org/10.3390/jcm10163513
  28. Jung DB, Jeong JE, Chung HL, Jang YY. Effect of overweight or obesity on lung function and asthma severity in prepubertal asthmatic children. Allergy, Asthma & Respiratory Disease. 2021;9(4):231-237. https://doi.org/10.4168/aard.2021.9.4.231
  29. Kamit Can F, Anil AB, Anil M, Zengin N, Durak F, Alparslan C, et al. Predictive factors for the outcome of high flow nasal cannula therapy in a pediatric intensive care unit: Is the SpO2/ FiO2 ratio useful? Journal of Critical Care. 2018;44:436-444. https://doi.org/10.1016/j.jcrc.2017.09.003
  30. Er A, Caglar A, Akgul F, Ulusoy E, Citlenbik H, Yilmaz D, et al. Early predictors of unresponsiveness to high-flow nasal cannula therapy in a pediatric emergency department. Pediatric Pulmonology. 2018;53(6):809-815. https://doi.org/10.1002/ppul.23981
  31. Nayani K, Naeem R, Munir O, Naseer N, Feroze A, Brown N, et al. The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department. BMC Pediatrics. 2018;18(1):339. https://doi.org/10.1186/s12887-018-1317-2
  32. Smith DK, Kuckel DP, Recidoro AM. Community-acquired pneumonia in children: Rapid evidence review. American Family Physician. 2021;104(6):618-625.
  33. Oto A, Erdogan S, Bosnak M. Oxygen therapy via high flow nasal cannula in pediatric intensive care unit. The Turkish Journal of Pediatrics. 2016;58(4):377-382. https://doi.org/10.24953/turkjped.2016.04.005