Optimized ROX index can predict transitioning to mechanical ventilation in acute hypoxic respiratory failure pediatric patients on HFNC:a real-world study
10.3760/cma.j.issn.1671-0282.2025.06.007
- VernacularTitle:ROX指数对呼吸衰竭儿童高流量氧疗失败的预测价值
- Author:
Yao LIU
1
;
Shaodong ZHAO
;
Mingxing FAN
;
Le JING
;
Hongjun MIAO
Author Information
1. 南京医科大学附属儿童医院药学部，南京 210008
- Keywords:
Acute hypoxemic respiratory failure;
Children;
Pediatric intensive care unit;
High-flow nasal cannula oxygen therapy;
ROX index;
ROP index;
ROXH index;
ROPH
- From:
Chinese Journal of Emergency Medicine
2025;34(6):782-788
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the predictive value of the ROX index and its modified versions for assessing the therapeutic efficacy of high-flow nasal cannula oxygen therapy (HFNC) in pediatric patients with acute hypoxemic respiratory failure (AHRF).Methods:This retrospective study analyzed clinical data from 130 AHRF children admitted to the Pediatric Intensive Care Unit (PICU) of Nanjing Medical University Affiliated Children’s Hospital between January 2020 and December 2024. Patients were categorized into two groups: HFNC success ( n=99) and HFNC failure ( n=31). Clinical parameters were compared between groups, and the predictive performance of the ROX index and its modified variants (ROP, ROXH, ROPH) at various time points was assessed. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for HFNC failure. Results:The HFNC failure group exhibited significantly higher baseline PaCO 2 levels (37.2 mmHg vs. 34.1 mmHg, P<0.05) and prolonged PICU stays (21 days vs. 12 days, P<0.01) compared to the success group. During treatment, the success group demonstrated marked improvements in oxygenation parameters (S/F ratio, P/F ratio) and ROX-derived indices (ROX, ROP, ROXH, ROPH) ( P<0.01). Multivariate analysis identified FiO 2 within 12 hours post-treatment and the ROPH index as independent predictors of HFNC failure ( P<0.05). ROC curve analysis revealed that the relative change in ROPH before and after treatment had the highest predictive accuracy (AUC=0.836, optimal cutoff=0.053, sensitivity=95.3%, specificity=70%) among all evaluated indices. Conclusions:Modified ROX indices, particularly the ROPH index, serve as reliable predictors of HFNC outcomes in children with AHRF. Dynamic monitoring of these indices may enable early identification of patients at risk for treatment failure, facilitating timely clinical intervention.
